Associations of Early-Life Exposure indoor environment with preschool children allergic rhinitis: A case-control study in Haikou city

Associations of Early-Life Exposure indoor environment with preschool children allergic rhinitis: A case-control study in Haikou city | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article Associations of Early-Life Exposure indoor environment with preschool children allergic rhinitis: A case-control study in Haikou city Qisheng Wu, Shiheng Fan, Bingxian Zhou, Zhuna Su, Chunyu Lu, Nengde Zhang, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4564895/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Objective: The study aimed to examine the association between allergic rhinitis and early-life indoor environmental exposure in preschool children in Haikou City, providing a scientific theoretical basis for the prevention of allergic rhinitis in this population. Methods: In January 2021, we conducted the China Child and Home Health (CCHH) study using a case-control approach with 1090 preschool children in Haikou City, Hainan Province, including 218 cases and 872 controls. The study included baseline demographic information, residential and indoor environmental characteristics, living habits, and children's allergies. Two-level logistical regression analysis was used to examine the association of Early-Life Exposure indoor environment with preschool children allergic rhinitis in terms of odds ratio (OR) and 95% confidence interval (CI). Results: Mother with an educational level of university or above (OR=1.443, 95% CI=1.024~2.035), having parental atopy (OR=4.604, 95% CI=3.339~6.349), damages or molds found in the mother's residence prior to pregnancy (OR=1.613, 95% CI=1.044~2.493), and passive smoking of the mother during pregnancy (OR=1.833, 95% CI=1.282~2.623) were risk factors for allergic rhinitis in preschool children. Conclusions: In this case-control study, we found significant associations between parental atopy, mother's education, and indoor environment in early life with the development of allergic rhinitis in preschool children. Therefore, prophylactic measures should be actively implemented in preschool children with allergic parental atopy, as well as preventing the mother's exposure to harmful factors in the indoor environment before and during pregnancy. Health sciences/Diseases Health sciences/Medical research Health sciences/Risk factors Allergic Rhinitis Indoor Environment Preschool Children Case-control Study Introdution Allergic rhinitis (AR) refers to a noninfectious inflammatory disease of the nasal mucosa involving multiple immunocompetent cells and cytokines mediated by IgE after allergen exposure in atopic individuals 1 . AR, one of the most common chronic respiratory diseases, is so low in symptoms that it causes most people to ignore the harm it causes. An important study from the Chinese lung health study group published in The Lancet in 2019 showed that AR is an important risk factor for asthma in adults 2 . In addition, AR can cause symptoms such as reduced learning ability and poor concentration in children and adolescents 3 . Since the beginning of the last century, the incidence of allergic diseases has shown a significant year-on-year trend, becoming a global public health problem that seriously threatens the quality of life and health of human beings 4 . In 2023 a data from the United States showed that the number of American adults diagnosed with AR amounted to 14.5% 5 . In the same year, a study of 1,934 adolescents in Greece found a prevalence of AR as high as 25.3% 6 . A 2012 study from 10 cities in China involving an indoor environment and child health (CCHH) showed a prevalence of physician-diagnosed AR ranging from 2.2–23.9% in Chinese preschool children 7 . Environmental factors as well as genetics play an important role in the development of AR 8 . A study in 2019 confirmed that exposure to environmental risk factors early in life may increase the prevalence of AR in children 9 . Early-life exposures played pivotal roles in determining the risk of allergic diseases throughout childhood and into adulthood 10 . Due to the rapid and immature development of the immune and respiratory systems during this period, fetuses and infants were particularly vulnerable to the adverse effects of air pollution 11 . Research shows that prenatal and early postnatal exposures can alter immune responses and cellular function, affecting the risk of allergies and other immune-related diseases later in life 12 . Thus, targeting critical indoor environment exposure window could contribute to the formulation of effective strategies for the prevention and intervention of AR in children. Hainan region is located in the tropics, perennial high temperature and high humidity climate, will lead to the indoor environment of the humid situation, and indoor quilts and clothes in the humid environment will be moldy as well as damage. In addition, with the change of people's lifestyles and Hainan's high-temperature environment, resulting in children's indoor activity time increases, long time in the closed space, it will be easy to come into contact with indoor dust mites, mold and other allergens, thus increasing the possibility of children's AR disease 13 . Therefore, this study was conducted in January 2021 to study Chinese Child and Home Health (CCHH) in 8 kindergarten preschool children in 4 districts of Haikou City, Hainan Province, China. It will explore the correlation between indoor environment in early life and children's AR, and provide a scientific theoretical basis for the prevention of AR in preschool children. 1. Methods 1.1 Study design and participants In January 2021, the authors used stratified random sampling, 4 administrative districts were first selected in the Haikou, which were Longhua District, Xiuying District, Qiongshan District, Meilan District. Then 2 kindergartens were randomly selected in each district. A total of 8 kindergartens were selected, and children with AR who diagnosed by doctors were investigated. In the same period, children who were sex -, age - and had not been diagnosed with AR in the same kindergartens were selected as controls in a 1:4 ratio of the case: control. Every control child was included in this study with equal probability. This study received ethical approval from the Ethics Committee of Hainan Medical College (No: HYLL-2022-244), and informed consent was obtained from the parents of the surveyed children. We also complied with all relevant ethical regulations regarding the use of the data in our study. All reports adhered to the Declaration of Helsinki. 1.2 Investigation contents and methods Questionnaires were developed for all children in the case group and control group; the questionnaire contents were adapted from the questionnaires used in the CCHH survey study and were slightly revised according to the specific context of Hainan City. The specific survey included: (1) Demographic characteristics, including age, gender, monthly income, duration of breastfeeding, parental atopy of allergies, and mode of birth; (2) Characteristics of dwellings and indoor environments, including type of house, indoor living conditions of pre-pregnant mothers, and indoor living conditions of children from 0 to 1 year of age; (3) Living habits, including whether fur-bearing animals are kept indoors and whether flowering plants are grown, smoking, how often the house is cleaned, and how well quilts and clothes are hung out to dry; (4) Allergy conditions in children, including asthma, rhinitis, eczema, food allergies and related conditions. 1.3. Determination of outcomes AR: The age of onset was determined by the time of the first diagnosis of AR, as reported by the parents that the child had been diagnosed with AR by a physician on at least one occasion. Passive smoking: Defined as a non-smoker being exposed to smoke from burning cigarettes for at least one day per week 14 . 1.4 Quality control In order to ensure the reliability, accuracy and validity of the data, this survey developed strict three-level quality control principles for the questionnaire: (1) Before the survey, the group contacted the Haikou Health Education Institute and the directors of the kindergartens, and firstly, the kindergarten school nurses and the teachers of the subclasses underwent a unified professional training to enable them to understand the purpose of the survey, the content of the questionnaire as well as the process of the survey. In addition, health education was given to the children's parents to explain the original purpose and significance of the survey and to improve the compliance of the study subjects. (2) During the survey process, the school nurse distributed the questionnaires to the classroom teachers, who distributed the questionnaires to the parents and explained the content of the questionnaires to the parents, who were allowed to take the questionnaires home and complete them and return them to the classroom teachers within one week. Then, teachers of all classes gave the completed questionnaires to the school nurse, who collected the completed questionnaires from all kindergarten classes and gave them to the Haikou Health Education Institute. (3) Post-survey quality control, the collected questionnaires were tested for internal logic and unqualified completed questionnaires were excluded to ensure the consistency of the data. The collected data were also double-entered using EpiData 3.0 software to ensure the accuracy of the data. 1.5 Statistical methods EpiData 3.1 was used to establish the database, and SPSS 26.0 software was used for data analysis and processing. Univariate analysis used the x 2 test. Linear regression model was used for covariance diagnosis so as to obtain the tolerance as well as variance inflation factor, which indicated that there was no covariance problem between independent variables when Tol > 0.1 and VIF < 10 between independent variables. Multivariate logistic regression was used to analyze the influencing factors of AR among preschool children in Haikou City. (Test level α = 0.05 two-sided). 2 Results 2.1 Demographic characteristics of participants A total of 218 cases and 872 controls were included in this study with a case to control ratio of 1:4. The mean age of the case group was 5.04 ± 1.08 years, comprising 140 boys and 78 girls. The control group was matched on the basis of sex and age, where the mean age of the control group was 5.04 ± 1.06 years, including 560 boys and 312 girls. There was no statistically significant difference in the distribution of ethnicity, mode of birth, whether the child was an only child, duration of breastfeeding, and father's education between the case and control groups ( P > 0.05). In contrast, the difference in the distribution of maternal education and family history of allergy between the case and control groups was statistically significant ( P < 0.05)(Table 1 ). Table 1 Demographics and characteristics of the AR and controls groups Factors AR group (%) Control group (%) χ 2 P Nation 0.065 0.800 Han 820(94.0) 204(93.6) Other ethnicities 52(6.0) 14(6.4) Mode of birth 1.661 0.197 Antepartum 561(64.3) 130(59.6) Cesarean section 311(35.7) 88(40.4) Only child 2.085 0.149 Yes 589(67.5) 136(62.4) No 283(32.5) 82(37.6) Breastfeeding < 6 months 371(42.5) 94(43.1) 0.023 0.878 ≥ 6 months 501(57.5) 124(56.9) Mother's education 7.788 0.005 High school and below 341(39.1) 63(28.9) College and above 531(60.9) 155(71.1) Father's education High school and below 309(35.4) 63(28.9) 3.315 0.069 College and above 563(64.6) 155(71.1) Parental atopy 107.145 < 0.001 No 624(71.6) 74(33.9) Yes 248(28.4) 144(66.1) 2.2 Univariate analysis of AR and indoor environmental factors The results of the univariate analysis of AR in preschool children in the current study showed that damage or mold was found in the mother's residence before pregnancy, damage or mold was found in the mother's residence during pregnancy, new furniture was added during the child's 0 ~ 1 year old period, new renovation was done during the child's 0 ~ 1 year old period, damage or mold was found in the child's residence during the child's 0 ~ 1 year old period, dampness or moldy phenomenon of the child's 0 ~ 1 year old clothing and bedding, the father's smoking, and the mother's passive smoking during pregnancy, Child 0 ~ 1 years old, passive smoking of the child, frequency of cleaning of the child's residence, and whether or not the child's bedding was air-dried were the main environmental factors for the occurrence of AR in preschool children in Haikou City ( P < 0.05) (Table 2 ). Table 2 Univariate analysis of AR and indoor environmental factors in preschool children between AR and control groups Factors AR group (%) Control group (%) χ 2 P Type of residence 1.906 0.386 multifamily 565(64.8) 152(69.7) single-family 141(16.2) 31(14.2) other 166(19.0) 35(16.1) Furniture was newly purchased in parents’ residence before pregnancy 2.435 0.119 No 738(84.6) 175(80.3) Yes 134(15.4) 43(19.7) Renovation in parents’ residence before pregnancy 0.000 1.000 No 812(93.1) 203(93.1) Yes 60(6.9) 15(6.9) Dampness or mold was noted in the parents’ residence before pregnancy 11.874 0.001 No 785(90.0) 178(81.7) Yes 87(10.0) 40(18.3) Damp or musty smell of mother's clothing and quilts before pregnancy 1.809 0.179 No 780(89.4) 188(86.2) Yes 92(10.6) 30(13.8) Furniture was newly purchased in the parents’ residence during pregnancy 2.669 0.102 No 799(91.6) 192(88.1) Yes 73(8.4) 26(11.9) Renovation in parents’ residence during pregnancy 1.856 0.173 No 835(95.8) 204(93.6) Yes 37(4.2) 14(6.4) Dampness or mold was noted in the parents’ residence during pregnancy 6.192 0.013 No 803(92.1) 189(86.7) Yes 69(7.9) 29(13.3) Damp or musty smell of mother's clothing and quilts during pregnancy 2.294 0.130 No 797(91.4) 192(88.1) Yes 75(8.6) 26(11.9) Furniture was newly purchased in children’s homes between 0 and 1 year of age 5.917 0.015 No 783(89.8) 183(83.9) Yes 89(10.2) 35(16.1) Residence renovation in children’s homes between 0 and 1 year of age 5.378 0.020 No 828(95.0) 198(90.8) Yes 44(5.0) 20(9.2) Dampness or mold was noted in the parents’ residence between 0 and 1 year of age 3.905 0.048 No 798(91.5) 190(87.2) Yes 74(8.5) 28(12.8) Damp or musty smell of mother's clothing and quilts between 0 and 1 year of age 5.451 0.020 No 810(92.9) 192(88.1) Yes 62(7.1) 26(11.9) A hairy pet was kept in children’s homes between 0 and 1 year of age 3.275 0.070 No 843(96.7) 205(94.0) Yes 29(3.3) 13(6.0) Flowering plants were grown in children’s homesbetween 0 and 1 year of age 0.417 0.519 No 833(95.5) 206(94.5) Yes 39(4.5) 12(5.5) Father smoking 4.137 0.042 No 479(54.9) 103(47.2) Yes 393(45.1) 115(52.8) Mother smoking 0.084 0.772 No 862(98.9) 216(99.1) Yes 10(1.1) 2(0.9) Passive smoking in the mother’s residence during pregnancy 12.240 < 0.001 No 703(80.6) 152(69.7) Yes 169(19.4) 66(30.3) Passive smoking in children’s homes between 0 and 1 year of age 8.890 0.003 No 687(78.8) 151(69.3) Yes 185(21.2) 67(30.7) Frequency of cleaning of children's residences 9.429 0.024 once a day 295(33.8) 68(31.2) 2 ~ 3 times/week 379(43.5) 80(36.7) once a week 167(19.2) 62(28.4) Less than once a week 31(3.5) 8(3.7) Whether the child's bedding is hung out to dry 8.153 0.017 No 11(1.3) 2(0.9) infrequent 199(22.8) 70(32.1) frequent 662(75.9) 146(67.0) 2.3 Multifactorial logistic regression analysis of AR in preschoolers In this study, whether AR was found in preschool children in Haikou City was used as the dependent variable, and the variables that were statistically significant in the results of the univariate analysis were used as the independent variables, followed by multifactorial logistic regression analysis. According to the results of covariance diagnosis, it was found that Tol > 0.1 and VIF < 5 among the independent variables, which indicated that there was no problem of covariance among the independent variables. The results of multifactorial logistic regression analysis showed that mothers' education of university and above, having allergic parental atopy, damage or mold found in mothers' residence before pregnancy, and mothers' passive smoking during pregnancy were the risk factors for AR in preschool children in Haikou City ( P < 0.05) (Table 3 ). Table 3 Multifactorial logistic regression analysis of AR in preschoolers Factors β SE Wald χ 2 P OR 95% CI Mother's education High school and below — — — — 1 — College and above 0.367 0.175 4.388 0.036 1.443 1.024 ~ 2.035 Parental atopy No — — — — 1 — Yes 1.527 0.164 86.735 < 0.001 4.604 3.339 ~ 6.349 Dampness or mold was noted in the parents’ residence before pregnancy No — — — — 1 — Yes 0.478 0.222 4.641 0.031 1.613 1.044 ~ 2.493 Passive smoking in the mother’s residence during pregnancy No — — — — 1 — Yes 0.606 0.183 11.006 0.001 1.833 1.282 ~ 2.623 3 Discussion To the best of our knowledge, this is the first case-control study in tropical China to assess the association between allergic rhinitis in preschool children and the indoor environment of their residences early in life. We found a significant association between the presence of damaged or mold found in the residence before the mother's pregnancy and passive smoking during the mother's pregnancy with AR in preschool children. We also found that the mother's education of university and above and having allergic biparental atopy were risk factors for AR in preschool children. Hainan Province, however, has a unique geographic location on an island in the tropics with high temperatures and high humidity climatic conditions all year round. This climate makes the indoor environment often humid, which in the long run can lead to the presence of mold and dust mites in the room. The pathogenesis of AR is related to genetic and environmental factors. In this study, we found that higher maternal education was a risk factor for AR in preschool children. lee et al.'s study of Korean adolescent AR also found this phenomenon 15 . This result is consistent with the so-called "hygiene hypothesis", which links hygienic environments to a higher prevalence of allergic diseases in the early stages of development. More educated mothers may be more inclined to adopt an over-cleaning lifestyle, and over-cleaning and small exposures to microorganisms may affect the development of the immune system, which may have an impact on the development of the child's immune system. And a more educated mother can mean that children have better access to advanced medical care, vaccinations and adequate nutrition. As a result, they have less exposure to allergens. In these cases, the Th2 cell pathway becomes stronger than the Th1 cell pathway, which increases the prevalence of allergic diseases 16 . This study also found that preschool children with allergic parental atopy had a higher prevalence of AR, which is consistent with the findings of Liu et al 17 . In recent years, more and more scholars have focused their studies on the influence of genetics on AR 18 . The heritability of AR has been estimated to be over 0.65 19 , and there have been more than 20 studies investigating genes for genetic susceptibility to AR in just the last 10 years. waage et al also identified 41 risk loci for AR in a 2018 genome-wide association study, including 20 novel loci, which suggests a high genetic susceptibility to AR 20,21 . AR is not only influenced by genetic factors, but environmental factors are equally important in AR. In this study, passive smoking during the mother's pregnancy was found to be a risk factor for AR in preschool children. Tobacco smoke contains at least 4,500 toxic compounds, including particulate matter, oxidizing gases, heavy metals, and at least 50 carcinogens 22 . Exposure to tobacco smoke at different times may affect children's health in different ways, and the prenatal period is a critical time for human development, during which exposure may begin as early as in utero due to maternal inhalation of other people's smoke and mother-initiated tobacco use, and may have effects on multiple systems 23 . The fetal immune system is in a developmental stage during pregnancy, and passive smoking exposure may interfere with this process. Chemicals in tobacco smoke, such as nicotine and carbon monoxide, may interfere with the normal development of the fetal immune system, making it more susceptible to reacting to allergens after birth and thus increasing the risk of AR. Therefore, during pregnancy, pregnant women should try to avoid smoking environments and avoid going to smoking places. Communicate with family members, friends and co-workers to make them aware of the dangers of smoking around pregnant women to the health of the fetus, encourage them to refrain from smoking in the presence of pregnant women, and raise their level of health literacy. And since Hainan Province is in a hot environment all year round and most children spend more than 90% of their time indoors, the indoor environment is crucial to children's health 24 . The present study identified damage or mold found in the residence of the mother prior to pregnancy as a risk factor for AR in preschool children. The results of a meta-analysis study similarly validated this finding that indoor mold increases the risk of developing AR 25 . Many epidemiologic studies have shown that prenatal and early life exposures to air pollution are more important than late life exposures due to the susceptibility of target organs and systems during life development, which is known as early life modeling 26 . Exposure to the external environment during pregnancy, when the embryo's organs are at a critical stage of development, may have long-term effects on the embryo. Therefore, exposure of mothers to harmful environments prior to pregnancy may affect the development of the embryo and increase the risk of AR in later childhood. In summary, the main factors affecting the development of AR in preschool children are genetic and environmental factors, which are unlikely to cause a significant increase in the prevalence of the disease in a short period of time, and the incomplete development of the immune system in children, which makes them more susceptible to the influence of environmental factors than adults. Therefore, preventive measures should be taken in preschool children with a family history of AR to protect mothers from exposure to harmful factors in the indoor environment before and during pregnancy. The present study also has some shortcomings: firstly, since the present study did not analyze the effect of outdoor environment on AR in preschool children, it could not comprehensively investigate the risk factors of AR in preschool children in Haikou City. Secondly, this study was conducted using questionnaires, which would have some risk of recall bias. Finally, our study included only one city, and we need to conduct studies in more cities and carry out large-sample cohort studies to strengthen etiologic inferences. Declarations Competing interests None declared. Ethics approval This research was approved by the Ethics Committee of Hainan Medical University (No: HYLL-2022-244). Funding This work was supported by the Innovative Scientific Research Projects for Postgraduates of Hainan Medical University in 2021 (No. HYYS2021B10). High-level Talents Scientific Research Start-up Fund of Hainan Medical University, 2019 (No. XRC190011). Author Contribution QW raised the study concept and drafted the manuscript. SF and BZ conceived and designed this work. QW, JP and NZ analysis the data. ZS, QW and CL provided inputs and revisions. JZ and DY design and guide this project. All authors reviewed the manuscript. Acknowledgements The authors thank all the participants of this study and all members involving the collection of the baseline data. Contributors QW raised the study concept and drafted the manuscript. SF and BZ conceived and designed this work. QW, JP and NZ analysis the data. ZS, QW and CL provided inputs and revisions. JZ and DY design and guide this project. All authors agree to submit this article. Data Availability The datasets generated and/or analyzed during the current study are not publicly available because the data belong to the School of Public Health of Fudan University. However, they are available from the corresponding author upon reasonable request. References Seidman, M. D. et al. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4564895","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":319818233,"identity":"a1dc5d48-b4ae-42fe-9e19-d12855dd4c8e","order_by":0,"name":"Qisheng Wu","email":"","orcid":"","institution":"Heinz Mehlhorn Academician Workstation, Hainan Medical University","correspondingAuthor":false,"prefix":"","firstName":"Qisheng","middleName":"","lastName":"Wu","suffix":""},{"id":319818234,"identity":"63f45d6d-6f62-4080-91e5-b5533e711061","order_by":1,"name":"Shiheng Fan","email":"","orcid":"","institution":"Heinz Mehlhorn Academician Workstation, Hainan Medical University","correspondingAuthor":false,"prefix":"","firstName":"Shiheng","middleName":"","lastName":"Fan","suffix":""},{"id":319818235,"identity":"5f5c2f06-aacc-4a7e-9f85-2f6ce8734901","order_by":2,"name":"Bingxian Zhou","email":"","orcid":"","institution":"Heinz Mehlhorn Academician Workstation, Hainan Medical University","correspondingAuthor":false,"prefix":"","firstName":"Bingxian","middleName":"","lastName":"Zhou","suffix":""},{"id":319818236,"identity":"b41368b6-98a0-4e0f-90db-c959c866e164","order_by":3,"name":"Zhuna Su","email":"","orcid":"","institution":"Heinz Mehlhorn Academician Workstation, Hainan Medical University","correspondingAuthor":false,"prefix":"","firstName":"Zhuna","middleName":"","lastName":"Su","suffix":""},{"id":319818237,"identity":"0de759ee-d697-41d0-b9c2-0460c4216a89","order_by":4,"name":"Chunyu Lu","email":"","orcid":"","institution":"Heinz Mehlhorn Academician Workstation, Hainan Medical University","correspondingAuthor":false,"prefix":"","firstName":"Chunyu","middleName":"","lastName":"Lu","suffix":""},{"id":319818238,"identity":"5b21d793-5604-4ab9-8661-9668d25f0817","order_by":5,"name":"Nengde Zhang","email":"","orcid":"","institution":"Heinz Mehlhorn Academician Workstation, Hainan Medical University","correspondingAuthor":false,"prefix":"","firstName":"Nengde","middleName":"","lastName":"Zhang","suffix":""},{"id":319818239,"identity":"9cca74bc-0414-4cfd-bc77-4d128771a034","order_by":6,"name":"Jianye Peng","email":"","orcid":"","institution":"Heinz Mehlhorn Academician Workstation, Hainan Medical University","correspondingAuthor":false,"prefix":"","firstName":"Jianye","middleName":"","lastName":"Peng","suffix":""},{"id":319818240,"identity":"c8dc2e90-c0a6-4330-9e81-3b823863957d","order_by":7,"name":"Dee Yu","email":"","orcid":"","institution":"Heinz Mehlhorn Academician Workstation, Hainan Medical University","correspondingAuthor":false,"prefix":"","firstName":"Dee","middleName":"","lastName":"Yu","suffix":""},{"id":319818241,"identity":"f4194bec-6c12-4763-97a5-474cea67e153","order_by":8,"name":"Jing Zhang","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA+0lEQVRIiWNgGAWjYDACCRDBAyTZexgYEiBiBkRq4TlDkhYwIwcuhl+L/OzmZw+/yFjkyUe+Pfjh4Y5t8gzszdskGGru4NTCOOeYubEMj0Sx4e28ZInEM7cNG3iOlUkwHHuGUwuzRIKZtASPROLG2TkGEolttxOALjSTYGw4jFMLm0T6N4iWmWeMf4C1yL/Br4UHaKbkB6CW+RI8ZlBbePBrkZDIKZMGakzcwJNjZgHUYtjGk1ZskXAMtxb5GenbJH/21CXObz9jfPNn2215fvbDG298qMGtBRwEvMCINzgA8x2ISMCrARjQP34ArWsgoGoUjIJRMApGLgAAEVpPq3/SPaMAAAAASUVORK5CYII=","orcid":"","institution":"Heinz Mehlhorn Academician Workstation, Hainan Medical University","correspondingAuthor":true,"prefix":"","firstName":"Jing","middleName":"","lastName":"Zhang","suffix":""}],"badges":[],"createdAt":"2024-06-11 14:36:10","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4564895/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4564895/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":67886425,"identity":"16a2e30a-01cc-4f05-8660-f11d4cf433c7","added_by":"auto","created_at":"2024-10-30 18:23:44","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1062549,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4564895/v1/118d4a80-b7c8-4aa3-9822-1a875721cda5.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Associations of Early-Life Exposure indoor environment with preschool children allergic rhinitis: A case-control study in Haikou city","fulltext":[{"header":"Introdution","content":"\u003cp\u003eAllergic rhinitis (AR) refers to a noninfectious inflammatory disease of the nasal mucosa involving multiple immunocompetent cells and cytokines mediated by IgE after allergen exposure in atopic individuals\u003csup\u003e1\u003c/sup\u003e. AR, one of the most common chronic respiratory diseases, is so low in symptoms that it causes most people to ignore the harm it causes. An important study from the Chinese lung health study group published in The \u003cem\u003eLancet\u003c/em\u003e in 2019 showed that AR is an important risk factor for asthma in adults\u003csup\u003e2\u003c/sup\u003e. In addition, AR can cause symptoms such as reduced learning ability and poor concentration in children and adolescents\u003csup\u003e3\u003c/sup\u003e. Since the beginning of the last century, the incidence of allergic diseases has shown a significant year-on-year trend, becoming a global public health problem that seriously threatens the quality of life and health of human beings\u003csup\u003e4\u003c/sup\u003e. In 2023 a data from the United States showed that the number of American adults diagnosed with AR amounted to 14.5%\u003csup\u003e5\u003c/sup\u003e. In the same year, a study of 1,934 adolescents in Greece found a prevalence of AR as high as 25.3%\u003csup\u003e6\u003c/sup\u003e. A 2012 study from 10 cities in China involving an indoor environment and child health (CCHH) showed a prevalence of physician-diagnosed AR ranging from 2.2\u0026ndash;23.9% in Chinese preschool children\u003csup\u003e7\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003eEnvironmental factors as well as genetics play an important role in the development of AR\u003csup\u003e8\u003c/sup\u003e. A study in 2019 confirmed that exposure to environmental risk factors early in life may increase the prevalence of AR in children\u003csup\u003e9\u003c/sup\u003e. Early-life exposures played pivotal roles in determining the risk of allergic diseases throughout childhood and into adulthood\u003csup\u003e10\u003c/sup\u003e. Due to the rapid and immature development of the immune and respiratory systems during this period, fetuses and infants were particularly vulnerable to the adverse effects of air pollution\u003csup\u003e11\u003c/sup\u003e. Research shows that prenatal and early postnatal exposures can alter immune responses and cellular function, affecting the risk of allergies and other immune-related diseases later in life\u003csup\u003e12\u003c/sup\u003e. Thus, targeting critical indoor environment exposure window could contribute to the formulation of effective strategies for the prevention and intervention of AR in children.\u003c/p\u003e\n\u003cp\u003eHainan region is located in the tropics, perennial high temperature and high humidity climate, will lead to the indoor environment of the humid situation, and indoor quilts and clothes in the humid environment will be moldy as well as damage. In addition, with the change of people's lifestyles and Hainan's high-temperature environment, resulting in children's indoor activity time increases, long time in the closed space, it will be easy to come into contact with indoor dust mites, mold and other allergens, thus increasing the possibility of children's AR disease\u003csup\u003e13\u003c/sup\u003e. Therefore, this study was conducted in January 2021 to study Chinese Child and Home Health (CCHH) in 8 kindergarten preschool children in 4 districts of Haikou City, Hainan Province, China. It will explore the correlation between indoor environment in early life and children's AR, and provide a scientific theoretical basis for the prevention of AR in preschool children.\u003c/p\u003e"},{"header":"1.\tMethods","content":"\u003cp style=\"display: inline !important;\"\u003e1.1 Study design and participants\u003c/p\u003e\n\u003cp\u003eIn January 2021, the authors used stratified random sampling, 4 administrative districts were first selected in the Haikou, which were Longhua District, Xiuying District, Qiongshan District, Meilan District. Then 2 kindergartens were randomly selected in each district. A total of 8 kindergartens were selected, and children with AR who diagnosed by doctors were investigated. In the same period, children who were sex -, age - and had not been diagnosed with AR in the same kindergartens were selected as controls in a 1:4 ratio of the case: control. Every control child was included in this study with equal probability. This study received ethical approval from the Ethics Committee of Hainan Medical College (No: HYLL-2022-244), and informed consent was obtained from the parents of the surveyed children. We also complied with all relevant ethical regulations regarding the use of the data in our study. All reports adhered to the Declaration of Helsinki.\u003c/p\u003e\n\u003cp\u003e1.2 Investigation contents and methods\u003c/p\u003e\n\u003cp\u003eQuestionnaires were developed for all children in the case group and control group; the questionnaire contents were adapted from the questionnaires used in the CCHH survey study and were slightly revised according to the specific context of Hainan City. The specific survey included: (1) Demographic characteristics, including age, gender, monthly income, duration of breastfeeding, parental atopy of allergies, and mode of birth; (2) Characteristics of dwellings and indoor environments, including type of house, indoor living conditions of pre-pregnant mothers, and indoor living conditions of children from 0 to 1 year of age; (3) Living habits, including whether fur-bearing animals are kept indoors and whether flowering plants are grown, smoking, how often the house is cleaned, and how well quilts and clothes are hung out to dry; (4) Allergy conditions in children, including asthma, rhinitis, eczema, food allergies and related conditions.\u003c/p\u003e\n\u003cp\u003e1.3. Determination of outcomes\u003c/p\u003e\n\u003col\u003e\n\u003cli\u003e\n\u003cp\u003eAR: The age of onset was determined by the time of the first diagnosis of AR, as reported by the parents that the child had been diagnosed with AR by a physician on at least one occasion.\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003ePassive smoking: Defined as a non-smoker being exposed to smoke from burning cigarettes for at least one day per week\u003csup\u003e14\u003c/sup\u003e.\u003c/p\u003e\n\u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003e1.4 Quality control\u003c/p\u003e\n\u003cp\u003eIn order to ensure the reliability, accuracy and validity of the data, this survey developed strict three-level quality control principles for the questionnaire: (1) Before the survey, the group contacted the Haikou Health Education Institute and the directors of the kindergartens, and firstly, the kindergarten school nurses and the teachers of the subclasses underwent a unified professional training to enable them to understand the purpose of the survey, the content of the questionnaire as well as the process of the survey. In addition, health education was given to the children's parents to explain the original purpose and significance of the survey and to improve the compliance of the study subjects. (2) During the survey process, the school nurse distributed the questionnaires to the classroom teachers, who distributed the questionnaires to the parents and explained the content of the questionnaires to the parents, who were allowed to take the questionnaires home and complete them and return them to the classroom teachers within one week. Then, teachers of all classes gave the completed questionnaires to the school nurse, who collected the completed questionnaires from all kindergarten classes and gave them to the Haikou Health Education Institute. (3) Post-survey quality control, the collected questionnaires were tested for internal logic and unqualified completed questionnaires were excluded to ensure the consistency of the data. The collected data were also double-entered using EpiData 3.0 software to ensure the accuracy of the data.\u003c/p\u003e\n\u003cp\u003e1.5 Statistical methods\u003c/p\u003e\n\u003cp\u003eEpiData 3.1 was used to establish the database, and SPSS 26.0 software was used for data analysis and processing. Univariate analysis used the \u003cem\u003ex\u003c/em\u003e\u003csup\u003e2\u003c/sup\u003e test. Linear regression model was used for covariance diagnosis so as to obtain the tolerance as well as variance inflation factor, which indicated that there was no covariance problem between independent variables when Tol\u0026thinsp;\u0026gt;\u0026thinsp;0.1 and VIF\u0026thinsp;\u0026lt;\u0026thinsp;10 between independent variables. Multivariate logistic regression was used to analyze the influencing factors of AR among preschool children in Haikou City. (Test level \u0026alpha;\u0026thinsp;=\u0026thinsp;0.05 two-sided).\u003c/p\u003e\n"},{"header":"2 Results","content":"\u003cp\u003e2.1 Demographic characteristics of participants\u003c/p\u003e\n\u003cp\u003eA total of 218 cases and 872 controls were included in this study with a case to control ratio of 1:4. The mean age of the case group was 5.04\u0026thinsp;\u0026plusmn;\u0026thinsp;1.08 years, comprising 140 boys and 78 girls. The control group was matched on the basis of sex and age, where the mean age of the control group was 5.04\u0026thinsp;\u0026plusmn;\u0026thinsp;1.06 years, including 560 boys and 312 girls. There was no statistically significant difference in the distribution of ethnicity, mode of birth, whether the child was an only child, duration of breastfeeding, and father's education between the case and control groups (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05). In contrast, the difference in the distribution of maternal education and family history of allergy between the case and control groups was statistically significant (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05)(Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003ctable id=\"Tab1\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003eDemographics and characteristics of the AR and controls groups\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eFactors\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eAR group (%)\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eControl group (%)\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003e\u0026chi;\u003c/em\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eNation\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.065\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.800\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eHan\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e820(94.0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e204(93.6)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eOther ethnicities\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e52(6.0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e14(6.4)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eMode of birth\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e1.661\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.197\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eAntepartum\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e561(64.3)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e130(59.6)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eCesarean section\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e311(35.7)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e88(40.4)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eOnly child\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e2.085\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.149\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e589(67.5)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e136(62.4)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e283(32.5)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e82(37.6)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eBreastfeeding\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026lt;\u0026thinsp;6 months\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e371(42.5)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e94(43.1)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.023\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.878\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026ge;\u0026thinsp;6 months\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e501(57.5)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e124(56.9)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eMother's education\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e7.788\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e\u003cstrong\u003e0.005\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eHigh school and below\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e341(39.1)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e63(28.9)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eCollege and above\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e531(60.9)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e155(71.1)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eFather's education\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eHigh school and below\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e309(35.4)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e63(28.9)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e3.315\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.069\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eCollege and above\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e563(64.6)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e155(71.1)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eParental atopy\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e107.145\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026lt;\u0026thinsp;0.001\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e624(71.6)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e74(33.9)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e248(28.4)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e144(66.1)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e2.2 Univariate analysis of AR and indoor environmental factors\u003c/p\u003e\n\u003cp\u003eThe results of the univariate analysis of AR in preschool children in the current study showed that damage or mold was found in the mother's residence before pregnancy, damage or mold was found in the mother's residence during pregnancy, new furniture was added during the child's 0\u0026thinsp;~\u0026thinsp;1 year old period, new renovation was done during the child's 0\u0026thinsp;~\u0026thinsp;1 year old period, damage or mold was found in the child's residence during the child's 0\u0026thinsp;~\u0026thinsp;1 year old period, dampness or moldy phenomenon of the child's 0\u0026thinsp;~\u0026thinsp;1 year old clothing and bedding, the father's smoking, and the mother's passive smoking during pregnancy, Child 0\u0026thinsp;~\u0026thinsp;1 years old, passive smoking of the child, frequency of cleaning of the child's residence, and whether or not the child's bedding was air-dried were the main environmental factors for the occurrence of AR in preschool children in Haikou City (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05) (Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003ctable id=\"Tab2\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003eUnivariate analysis of AR and indoor environmental factors in preschool children between AR and control groups\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eFactors\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eAR group (%)\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eControl group (%)\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003e\u0026chi;\u003c/em\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eType of residence\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e1.906\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.386\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003emultifamily\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e565(64.8)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e152(69.7)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003esingle-family\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e141(16.2)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e31(14.2)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eother\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e166(19.0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e35(16.1)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eFurniture was newly purchased in parents\u0026rsquo; residence before pregnancy\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e2.435\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.119\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e738(84.6)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e175(80.3)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e134(15.4)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e43(19.7)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eRenovation in parents\u0026rsquo; residence before pregnancy\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.000\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e1.000\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e812(93.1)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e203(93.1)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e60(6.9)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e15(6.9)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eDampness or mold was noted in the parents\u0026rsquo; residence before pregnancy\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e11.874\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e\u003cstrong\u003e0.001\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e785(90.0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e178(81.7)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e87(10.0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e40(18.3)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eDamp or musty smell of mother's clothing and quilts before pregnancy\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e1.809\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.179\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e780(89.4)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e188(86.2)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e92(10.6)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e30(13.8)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eFurniture was newly purchased in the parents\u0026rsquo; residence during pregnancy\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e2.669\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.102\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e799(91.6)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e192(88.1)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e73(8.4)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e26(11.9)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eRenovation in parents\u0026rsquo; residence during pregnancy\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e1.856\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.173\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e835(95.8)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e204(93.6)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e37(4.2)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e14(6.4)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eDampness or mold was noted in the parents\u0026rsquo; residence during pregnancy\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e6.192\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e\u003cstrong\u003e0.013\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e803(92.1)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e189(86.7)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e69(7.9)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e29(13.3)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eDamp or musty smell of mother's clothing and quilts during pregnancy\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e2.294\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.130\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e797(91.4)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e192(88.1)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e75(8.6)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e26(11.9)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eFurniture was newly purchased in children\u0026rsquo;s homes between 0 and 1 year of age\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e5.917\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e\u003cstrong\u003e0.015\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e783(89.8)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e183(83.9)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e89(10.2)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e35(16.1)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eResidence renovation in children\u0026rsquo;s homes between 0 and 1 year of age\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e5.378\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e\u003cstrong\u003e0.020\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e828(95.0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e198(90.8)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e44(5.0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e20(9.2)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eDampness or mold was noted in the parents\u0026rsquo; residence between 0 and 1 year of age\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e3.905\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e\u003cstrong\u003e0.048\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e798(91.5)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e190(87.2)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e74(8.5)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e28(12.8)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eDamp or musty smell of mother's clothing and quilts between 0 and 1 year of age\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e5.451\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e\u003cstrong\u003e0.020\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e810(92.9)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e192(88.1)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e62(7.1)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e26(11.9)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eA hairy pet was kept in children\u0026rsquo;s homes between 0 and 1 year of age\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e3.275\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.070\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e843(96.7)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e205(94.0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e29(3.3)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e13(6.0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eFlowering plants were grown in children\u0026rsquo;s homesbetween 0 and 1 year of age\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.417\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.519\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e833(95.5)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e206(94.5)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e39(4.5)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e12(5.5)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eFather smoking\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e4.137\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e\u003cstrong\u003e0.042\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e479(54.9)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e103(47.2)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e393(45.1)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e115(52.8)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eMother smoking\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.084\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.772\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e862(98.9)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e216(99.1)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e10(1.1)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e2(0.9)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003ePassive smoking in the mother\u0026rsquo;s residence during\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003epregnancy\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e12.240\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026lt;\u0026thinsp;0.001\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e703(80.6)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e152(69.7)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e169(19.4)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e66(30.3)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003ePassive smoking in children\u0026rsquo;s homes between 0 and 1 year of age\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e8.890\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e\u003cstrong\u003e0.003\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e687(78.8)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e151(69.3)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e185(21.2)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e67(30.7)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eFrequency of cleaning of children's residences\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e9.429\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e\u003cstrong\u003e0.024\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eonce a day\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e295(33.8)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e68(31.2)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2\u0026thinsp;~\u0026thinsp;3 times/week\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e379(43.5)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e80(36.7)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eonce a week\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e167(19.2)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e62(28.4)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eLess than once a week\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e31(3.5)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e8(3.7)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eWhether the child's bedding is hung out to dry\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e8.153\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e\u003cstrong\u003e0.017\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e11(1.3)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e2(0.9)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003einfrequent\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e199(22.8)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e70(32.1)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003efrequent\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e662(75.9)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e146(67.0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e2.3 Multifactorial logistic regression analysis of AR in preschoolers\u003c/p\u003e\n\u003cp\u003eIn this study, whether AR was found in preschool children in Haikou City was used as the dependent variable, and the variables that were statistically significant in the results of the univariate analysis were used as the independent variables, followed by multifactorial logistic regression analysis. According to the results of covariance diagnosis, it was found that Tol\u0026thinsp;\u0026gt;\u0026thinsp;0.1 and VIF\u0026thinsp;\u0026lt;\u0026thinsp;5 among the independent variables, which indicated that there was no problem of covariance among the independent variables. The results of multifactorial logistic regression analysis showed that mothers' education of university and above, having allergic parental atopy, damage or mold found in mothers' residence before pregnancy, and mothers' passive smoking during pregnancy were the risk factors for AR in preschool children in Haikou City (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05) (Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003ctable id=\"Tab3\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003eMultifactorial logistic regression analysis of AR in preschoolers\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eFactors\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003e\u0026beta;\u003c/em\u003e\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003eSE\u003c/em\u003e\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003eWald \u0026chi;\u003c/em\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003eOR\u003c/em\u003e\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003e95% \u003cem\u003eCI\u003c/em\u003e\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eMother's education\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eHigh school and below\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026mdash;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026mdash;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026mdash;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026mdash;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026mdash;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eCollege and above\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.367\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.175\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e4.388\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.036\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.443\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.024\u0026thinsp;~\u0026thinsp;2.035\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eParental atopy\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026mdash;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026mdash;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026mdash;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026mdash;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026mdash;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.527\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.164\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e86.735\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e4.604\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e3.339\u0026thinsp;~\u0026thinsp;6.349\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eDampness or mold was noted in the parents\u0026rsquo; residence before pregnancy\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026mdash;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026mdash;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026mdash;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026mdash;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026mdash;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.478\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.222\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e4.641\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.031\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.613\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.044\u0026thinsp;~\u0026thinsp;2.493\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003ePassive smoking in the mother\u0026rsquo;s residence during pregnancy\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026mdash;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026mdash;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026mdash;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026mdash;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026mdash;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.606\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.183\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e11.006\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.001\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.833\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.282\u0026thinsp;~\u0026thinsp;2.623\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n"},{"header":"3 Discussion","content":"\u003cp\u003eTo the best of our knowledge, this is the first case-control study in tropical China to assess the association between allergic rhinitis in preschool children and the indoor environment of their residences early in life. We found a significant association between the presence of damaged or mold found in the residence before the mother's pregnancy and passive smoking during the mother's pregnancy with AR in preschool children. We also found that the mother's education of university and above and having allergic biparental atopy were risk factors for AR in preschool children. Hainan Province, however, has a unique geographic location on an island in the tropics with high temperatures and high humidity climatic conditions all year round. This climate makes the indoor environment often humid, which in the long run can lead to the presence of mold and dust mites in the room.\u003c/p\u003e\n\u003cp\u003eThe pathogenesis of AR is related to genetic and environmental factors. In this study, we found that higher maternal education was a risk factor for AR in preschool children. lee et al.'s study of Korean adolescent AR also found this phenomenon\u003csup\u003e15\u003c/sup\u003e. This result is consistent with the so-called \"hygiene hypothesis\", which links hygienic environments to a higher prevalence of allergic diseases in the early stages of development. More educated mothers may be more inclined to adopt an over-cleaning lifestyle, and over-cleaning and small exposures to microorganisms may affect the development of the immune system, which may have an impact on the development of the child's immune system. And a more educated mother can mean that children have better access to advanced medical care, vaccinations and adequate nutrition. As a result, they have less exposure to allergens. In these cases, the Th2 cell pathway becomes stronger than the Th1 cell pathway, which increases the prevalence of allergic diseases\u003csup\u003e16\u003c/sup\u003e. This study also found that preschool children with allergic parental atopy had a higher prevalence of AR, which is consistent with the findings of Liu et al\u003csup\u003e17\u003c/sup\u003e. In recent years, more and more scholars have focused their studies on the influence of genetics on AR\u003csup\u003e18\u003c/sup\u003e. The heritability of AR has been estimated to be over 0.65\u003csup\u003e19\u003c/sup\u003e, and there have been more than 20 studies investigating genes for genetic susceptibility to AR in just the last 10 years. waage et al also identified 41 risk loci for AR in a 2018 genome-wide association study, including 20 novel loci, which suggests a high genetic susceptibility to AR\u003csup\u003e20,21\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003eAR is not only influenced by genetic factors, but environmental factors are equally important in AR. In this study, passive smoking during the mother's pregnancy was found to be a risk factor for AR in preschool children. Tobacco smoke contains at least 4,500 toxic compounds, including particulate matter, oxidizing gases, heavy metals, and at least 50 carcinogens\u003csup\u003e22\u003c/sup\u003e. Exposure to tobacco smoke at different times may affect children's health in different ways, and the prenatal period is a critical time for human development, during which exposure may begin as early as in utero due to maternal inhalation of other people's smoke and mother-initiated tobacco use, and may have effects on multiple systems\u003csup\u003e23\u003c/sup\u003e. The fetal immune system is in a developmental stage during pregnancy, and passive smoking exposure may interfere with this process. Chemicals in tobacco smoke, such as nicotine and carbon monoxide, may interfere with the normal development of the fetal immune system, making it more susceptible to reacting to allergens after birth and thus increasing the risk of AR. Therefore, during pregnancy, pregnant women should try to avoid smoking environments and avoid going to smoking places. Communicate with family members, friends and co-workers to make them aware of the dangers of smoking around pregnant women to the health of the fetus, encourage them to refrain from smoking in the presence of pregnant women, and raise their level of health literacy. And since Hainan Province is in a hot environment all year round and most children spend more than 90% of their time indoors, the indoor environment is crucial to children's health\u003csup\u003e24\u003c/sup\u003e. The present study identified damage or mold found in the residence of the mother prior to pregnancy as a risk factor for AR in preschool children. The results of a meta-analysis study similarly validated this finding that indoor mold increases the risk of developing AR\u003csup\u003e25\u003c/sup\u003e. Many epidemiologic studies have shown that prenatal and early life exposures to air pollution are more important than late life exposures due to the susceptibility of target organs and systems during life development, which is known as early life modeling\u003csup\u003e26\u003c/sup\u003e. Exposure to the external environment during pregnancy, when the embryo's organs are at a critical stage of development, may have long-term effects on the embryo. Therefore, exposure of mothers to harmful environments prior to pregnancy may affect the development of the embryo and increase the risk of AR in later childhood.\u003c/p\u003e\n\u003cp\u003eIn summary, the main factors affecting the development of AR in preschool children are genetic and environmental factors, which are unlikely to cause a significant increase in the prevalence of the disease in a short period of time, and the incomplete development of the immune system in children, which makes them more susceptible to the influence of environmental factors than adults. Therefore, preventive measures should be taken in preschool children with a family history of AR to protect mothers from exposure to harmful factors in the indoor environment before and during pregnancy. The present study also has some shortcomings: firstly, since the present study did not analyze the effect of outdoor environment on AR in preschool children, it could not comprehensively investigate the risk factors of AR in preschool children in Haikou City. Secondly, this study was conducted using questionnaires, which would have some risk of recall bias. Finally, our study included only one city, and we need to conduct studies in more cities and carry out large-sample cohort studies to strengthen etiologic inferences.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e \u003ch2\u003eCompeting interests\u003c/h2\u003e \u003cp\u003eNone declared.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eEthics approval\u003c/strong\u003e \u003cp\u003e This research was approved by the Ethics Committee of Hainan Medical University (No: HYLL-2022-244).\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eFunding\u003c/h2\u003e \u003cp\u003eThis work was supported by the Innovative Scientific Research Projects for Postgraduates of Hainan Medical University in 2021 (No. HYYS2021B10). High-level Talents Scientific Research Start-up Fund of Hainan Medical University, 2019 (No. XRC190011).\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eQW raised the study concept and drafted the manuscript. SF and BZ conceived and designed this work. QW, JP and NZ analysis the data. ZS, QW and CL provided inputs and revisions. JZ and DY design and guide this project. All authors reviewed the manuscript.\u003c/p\u003e\u003ch2\u003eAcknowledgements\u003c/h2\u003e \u003cp\u003eThe authors thank all the participants of this study and all members involving the collection of the baseline data.\u003c/p\u003e \u003cp\u003e\u003cb\u003eContributors\u003c/b\u003e QW raised the study concept and drafted the manuscript. SF and BZ conceived and designed this work. QW, JP and NZ analysis the data. ZS, QW and CL provided inputs and revisions. JZ and DY design and guide this project. All authors agree to submit this article.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eThe datasets generated and/or analyzed during the current study are not publicly available because the data belong to the School of Public Health of Fudan University. However, they are available from the corresponding author upon reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003e Seidman, M. D. \u003cem\u003eet al.\u003c/em\u003e Clinical practice guideline: Allergic rhinitis. \u003cem\u003eOtolaryngology\u0026ndash;head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery\u003c/em\u003e \u003cb\u003e152\u003c/b\u003e, S1-43, doi:10.1177/0194599814561600 (2015).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003e Huang, K. \u003cem\u003eet al.\u003c/em\u003e Prevalence, risk factors, and management of asthma in China: a national cross-sectional study. \u003cem\u003eLancet (London, England)\u003c/em\u003e \u003cb\u003e394\u003c/b\u003e, 407\u0026ndash;418, doi:10.1016/s0140-6736(19)31147-x (2019).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003e Blaiss, M. S. 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The study included baseline demographic information, residential and indoor environmental characteristics, living habits, and children's allergies. Two-level logistical regression analysis was used to examine the association of Early-Life Exposure indoor environment with preschool children allergic rhinitis in terms of odds ratio (OR) and 95% confidence interval (CI).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eMother with an educational level of university or above (OR=1.443, 95% CI=1.024~2.035), having parental atopy (OR=4.604, 95% CI=3.339~6.349), damages or molds found in the mother's residence prior to pregnancy (OR=1.613, 95% CI=1.044~2.493), and passive smoking of the mother during pregnancy (OR=1.833, 95% CI=1.282~2.623) were risk factors for allergic rhinitis in preschool children.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions:\u003c/strong\u003e In this case-control study, we found significant associations between parental atopy, mother's education, and indoor environment in early life with the development of allergic rhinitis in preschool children. Therefore, prophylactic measures should be actively implemented in preschool children with allergic parental atopy, as well as preventing the mother's exposure to harmful factors in the indoor environment before and during pregnancy.\u003c/p\u003e","manuscriptTitle":"Associations of Early-Life Exposure indoor environment with preschool children allergic rhinitis: A case-control study in Haikou city","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-06-28 05:35:15","doi":"10.21203/rs.3.rs-4564895/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"e803ca90-a08e-4b63-b54b-e31c6dbd2210","owner":[],"postedDate":"June 28th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":33816806,"name":"Health sciences/Diseases"},{"id":33816807,"name":"Health sciences/Medical research"},{"id":33816808,"name":"Health sciences/Risk factors"}],"tags":[],"updatedAt":"2024-10-30T18:23:25+00:00","versionOfRecord":[],"versionCreatedAt":"2024-06-28 05:35:15","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4564895","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4564895","identity":"rs-4564895","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}