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Residential dampness and mold with dose-response relationships to health: a review



Just published as an accepted article in the Indoor Air Journal



Review Article

Observation-based metrics for residential dampness and mold with dose-response relationships to health: a review


Mark J. Mendell and Kazukiyo Kumagai,

(California Department of Health, Richmond, California)


Accepted manuscript online: 24 September 2016

DOI: 10.1111/ina.12342


This article has been accepted for publication and undergone full peer review but has not been through the copyediting, typesetting, pagination and proofreading process, which may lead to differences between this version and the Version of Record.

Please cite this article as doi: 10.1111/ina.12342


An important proportion of respiratory illness is considered attributable to residential dampness or mold (D/M). Developing health-protective D/M guidelines has been challenging, in part because unhealthy levels of indoor D/M cannot be defined using available microbiological measurements. This review paper explores reported multi-level, observation-based (e.g., visual or olfactory) D/M metrics for potential in defining unhealthy levels of residential D/M. For many of the 33 multi-level residential D/M metrics identified, health risks generally increased as observed D/M increased. Although some metrics seemed too complex for practical use, simple metrics had among the strongest associations with health outcomes. Available findings suggest the feasibility of setting observation-based D/M thresholds to trigger remedial action, using further improved but practical D/M metrics without microbiological measurements (at least until the actual dampness-related agents that cause illness are better quantified). Additional data would allow setting health-protective D/M thresholds more precisely. Also, metrics could better reflect hidden D/M by including mold odor, which has demonstrated strong associations with health effects.


My own view is that there is a little fuzziness in the term “dampness or mold” (D/M) but that this reflects the complexity of the relationships between the many factors that can contribute to microbial growth and to the possible impact/effect of such growth on occupant health.

We welcome other opinions. Please send yours to



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