DE LA SALLE HEALTH SCIENCES INSTITUTE COLLEGE OF MEDICINE

DEPARTMENT OF FAMILY AND COMMUNITY MEDICINE

CM2 SY 2011-2012


REVISED OUTPUT 7: RESEARCH PROTOCOL
~Exposure to Air-conditioning Systems in Classrooms Leads to Mild Severity of Allergic Rhinitis in
Second Year High School Students of Selected Schools in Dasmarias City, Cavite: A Cross-
Sectional Study.

SUBMITTED ON:
November 8, 2011


SUBMITTED TO:
DR. JOVILIA M. ABONG

SUBMITTED BY:
GROUP 1A
ARCAIRA, JOSHUA A.
ABAD, MARY RAINA ANGELI
ANCHETA, JONATHAN
BASUL, CHARINE
CARAVEO, JULIEN NICOLE
CRUZ, SPICA
ESPINOZA, FAITH KRISTINE
GARCIA, RAY WILSON
KALALO, GERARD MICHAEL
1

OUTPUT 7: RESEARCH PROTOCOL
GROUP 1A, DR. 1OVILIA M. ABONG

I. INTRODUCTION
Research Question and Hypothesis
Research Question:
Among second year high school students with allergic rhinitis oI selected schools in Dasmarias, Cavite,
will exposure to air-conditioned school rooms aIIect the severity oI their allergic rhinitis?

Research Hypothesis:
Exposure to air-conditioned rooms alleviates the symptoms and occurrence oI allergic rhinitis and poor
ventilation leads to its severity.

Background of the Research Question
The researchers are concerned with the Iact that in the Asia-PaciIic region, especially in the low- and
middle- income countries, the prevalence oI allergic rhinitis has increased Irom 5 to 45 and moreover,
the Philippines has ranked with the highest prevalence oI rhinitis and asthma among other Asian
countries.
|1|, |2|
With this the researchers deemed to determine the Iactors that may lead to the
exacerbation oI allergic rhinitis and in turn discover methods oI how to prevent the progression oI its
severity. AR has been shown to decrease perIormance oI students in school leading to absenteeism oI
students.
|3|
Poor ventilation in the classrooms lead to increased exposure to allergens such as pollen,
cockroaches, and molds that may ultimately lead to the exacerbation oI the student`s AR interIering with
the student`s capacity to do his/her daily activities.
|4|, |5|
Hence the researchers wish to determine iI there
is an association between exposure to air-conditioning systems in the classrooms and the occurrence oI
mild allergic rhinitis.

Significance of the Study
In attempt to determine the classroom environment that would lead to less occurrence oI symptoms oI AR
leading to mild severity AR, the researchers would like to contribute somehow in helping the students
cope with their condition and be able to maximize their potential in school.
II. RESEARCH OB1ECTIVES
General Objective: To determine iI the exposure to the air-conditioning system aIIects the severity
oI allergic rhinitis in second year high school students oI selected schools in Dasmarias, Cavite.

Specific Objectives:
1. To identiIy the prevalence oI allergic rhinitis among second year high school students oI
selected schools in oI Dasmarias, Cavite based on their classroom conditions (air-conditioned
vs. non-air-conditioned).
2. To determine the severity oI allergic rhinitis according to ARIA classiIications.
2

3. To identiIy the risk Iactors oI allergic rhinitis present in the classroom or school, such as the
presence oI molds, chalk dust, house dust, and cockroaches.
4. Compare the severity oI allergic rhinitis in students who are exposed to air-conditioned
classrooms and those who are not exposed to air-conditioned classrooms.

III. LITERATURE REVIEW
Epidemiology of Disease of interest

According to a demographic and epidemiologic study by Settipane, allergic rhinitis aIIects more than
20 oI the American population.
|1|
This percentage is alarming on its own, making allergic rhinitis Iairly
common among the population. Furthermore, it was observed by the ISAAC (International Study oI
Allergy and Asthma in Children) that the Philippines was ranked with the highest prevalence rate oI
common allergies (rhinitis and asthma) - encompassing countries like Thailand, Indonesia, and South
Korea. These studies have triggered interest into the disease and have inspired us to study the disease
Iurther as well.
|2|

From the same study by the ISAAC, they discovered that among Filipino teenagers, 13-14 year-
olds presented with the highest prevalence rate among age groups with 32.5 oI them having allergic
rhinitis.
|2|
Hence, our study will be Iocusing on the high school year level where the speciIic age group
mentioned is Iound.
Ventilation and air-conditioning systems can be sources oI microbial aerosols either Irom
contaminated air entering the system or directly Irom microbial growth within the system. Poor
ventilation may allow an accumulation oI particulates, pollutants, and allergens inside school buildings
and decreased air circulation may increase transmission oI respiratory inIections. Building structural
problems, such as heating or air conditioning systems venting near an air intake may contribute to these
exposures. Due to this, the associations between school absenteeism and poor ventilation, vermin, and
cumulative exposure to building condition problems are greater Ior younger students. Young children,
aged 5 to 18 years old, are also known to be more susceptible to airborne pollutants than adults because oI
their greater activity, smaller airways, and Iaster ventilation rates.
|3|
ThereIore, it is important to look into
which oI the learning environments is more likely to help students achieve their Iull potential and keep
them healthy.
According to Meltzer, approximately one in Iive children will develop symptoms oI allergic
rhinitis by two to three years oI age. In children who are six years oI age, about 40 oI them will have
symptoms and up to 30 will be aIIected during their adolescence.
|4|
Furthermore, a study by Blaiss
pointed out that allergic rhinitis can interIere with a child`s daily activities such as learning in school. It
also aIIects a child`s behavior and psychosocial health thus aIIecting the child`s quality oI liIe overall.
Due to this, a consensus panel was Iormed in 2004 to assess the impact allergic rhinitis has on school
children and determine how to improve prevention and treatment, so an aIIected child`s quality oI liIe and
school perIormance could improve. One oI the things they considered in this consensus is that poor
environmental conditions, such as places that have inadequate ventilation or poor indoor quality, can
exacerbate allergic rhinitis. It is advised that the best way to prevent allergic rhinitis Irom occurring is by
providing clean indoor environments that will reduce the amount oI allergens present indoors. This
includes having an air-conditioning system and proper ventilation.
|4|, |5|

3

Risk factors and possible Confounding variables of the study

Allergens/Irritants
Allergens and irritants present in the environment are part oI the conIounding variables oI the study. One
oI the allergens that commonly trigger allergic rhinitis is pollen. In a cohort study conducted in Sweden in
2003, it has been identiIied that pollen accounted Ior seventy-three percent (73) oI the trigger Iactors
that cause allergic rhinitis.
|6|
Moreover, the incidence oI allergic disease has been thought to be
constantly increasing
|7|
and this has been attributed to the increased exposure oI children to air pollution,
probably because oI the presence oI particulates in the air.
|8|
. The condition oI the classroom, as will be
surveyed upon implementation oI the study, is a conIounding variable to this research because as already
mentioned, allergens comprise a big part oI the triggers oI allergic rhinitis and these allergens or irritants
may be present in the classroom in the Iorm oI dust Irom unwashed curtains, carpets, or table cloths that
may trigger a more severe allergic reaction. Furthermore, exposure to chalk dust, especially in a poorly
ventilated classroom, may also trigger allergic rhinitis oI the aIIected students.

Epidemiology of Exposure/Factor of interest
According to Busse, an allergic reaction is usually caused by an allergen. In the cases oI people with
allergic rhinitis, when they breathe in these allergens such as pollens or dust, these cause their bodies to
release certain chemicals like histamine, bradykinin, and the like. These chemicals cause the persons with
AR to experience symptoms oI allergic reactions such as itching, swelling, and mucous production.
Pollens that cause AR may diIIer depending on the person who inhales such pollens. Usually the smaller,
hard-to-see pollens cause AR more oIten than the bigger ones. Examples oI plants that produce the said
pollens are deciduous and evergreen trees, grasses, and ragweed. Development oI symptoms may depend
on the amount oI pollen present in the air. During dry, hot, windy days there may be more pollens present
in the air thus, the increasing the probability oI developing symptoms oI AR. However, during cool,
damp, rainy days pollens may not be abundant in the air since they would most likely be washed in the
ground. Reactions to allergens may also include eczema and asthma which are also part oI the allergic
reaction. The most common cause oI developing AR is still genetic in nature. The chance oI having AR is
high iI both parents have the disease.
|9|

Togias stated that inIlammatory mediators produced by mast cells that are activated by antigen-
IgE cause the symptoms oI AR. The mediators directly or indirectly target the end organs. For example,
the histamine released by mast cells stimulates the sensory nerves which lead to sneezing, pruritus,
rhinorrhea, and nasal congestion. Symptoms may also arise due to the phenomenon oI hyper-
responsiveness to non-allergenic stimuli like cold air and other irritants. The phenomenon is believed to
have arisen Irom the allergic inIlammation on the sensory nerves that supply the mucosa oI the upper
respiratory tract mucosa. DiIIerent kinds oI non-allergenic triggers were shown to act on the nasal mucosa
by the means oI sensorineural stimulation. The responsiveness to these stimuli is also heightened in AR
compared to healthy individuals. Also, stimulation oI sensory nerves can produce inIlammatory changes
in AR. Such inIlammation is called neurogenic inIlammation but the mechanism behind this is not yet
known. However, Alkis also stated that evidence exists that neurotrophin nerve growth Iactor, the one
responsible Ior the changes in the sensory nerves, is Iound in elevated levels in the nasal secretions oI
persons with perennial AR compared to healthy individuals. The nerve growth Iactor is also acutely
4

released into nasal Iluids aIter being triggered by allergens in patients with allergic disease. AR is also
very common among patients with asthma oI atopic origin.
|10|
Accurate records on the prevalence oI allergic rhinitis are lacking beIore the 20
th
century.
According to a demographic and epidemiologic study by Settipane, allergic rhinitis aIIects more than
20 oI the American population.
|9|
The study showed that 64 oI 1836 students originally tested 23
years ago were Iollowed up. Seventeen new cases oI asthma (10.5) have developed in the 162 subjects
who previously suIIered Irom seasonal AR. Nineteen new cases oI asthma (3.6) had developed in the
528 subjects without previous symptoms. Subjects without symptoms but had previous positive skin prick
tests were somewhat more likely to have developed asthma compared to people with negative tests
(10.6 versus 3.2).
|11|, |12|

Summary of Related Studies
According to Kutintara, allergic rhinitis (AR) is the most common oI all allergic diseases. The prevalence,
which ranges Irom 4 to 40, oI this disease is spreading worldwide, including the Asia PaciIic region.
It has a great impact on a person`s daily liIe. 82 oI AR suIIerers in the United States reported that they
always or usually have symptoms at work or school. It is responsible Ior about 2 million lost school-days
each year in the United States and a signiIicant large number oI Thai children indicated that their allergy
symptoms were severe enough to limit their activities.
|13|


Another study in Spain conducted by Jauregui et. al. states that AR is the most common chronic
disorder that aIIects the pediatric population.
|16|
Data shows that AR and rhinoconjunctivitis represent the
main cause oI 55.5 oI all patients seen in Spanish allergology clinics. Again, it is important to note that
a third oI the population oI 13-14 year-old teenagers suIIer Irom the symptoms oI AR.
|17|
It has been also
stated in the study that AR somehow impairs daily activities such as visual coordination, retention
capacity, and reaction time oI students.
|18|

Avoidance is the primary method in treating AR. Those with allergies can reduce their allergic
symptoms by reducing their exposure to allergens. This includes promoting a healthy indoor environment.
The main allergens that are Iound indoors are allergens Irom dust mites, cockroaches, and molds. These
allergens can be avoided by knowing how to eliminate them. These allergens commonly survive in
environments that are warm, moist and humid. Dust mites cannot live in an environment that has a
relative humidity oI less than 50 while cockroaches and molds only thrive in areas oI warmth and
humidity. ThereIore, other than keeping an AR patient`s surrounding environment clean, it is also
recommended to have an air-conditioning system or proper ventilation system so that it can reduce the
amount oI allergens present in the patient`s environment by reducing the humidity and heat levels.
|13|


In congruence with the aIorementioned study, according to Zacharisen, a member and a Iellow oI
the American Academy oI Asthma, Allergy, and Immunology, the key to reducing the severity oI
symptoms a child experiences at school is avoidance oI these allergens. II it is possible, parents should
talk to school personnel to make them aware oI the allergy triggers oI their children so as to avoid
aggravating their allergies.
|14|

A study in Boston conducted by Blaisse stated that the symptoms oI allergic rhinitis and the
adverse eIIects oI medications taken can diminish or lessen the cognitive Iunction and learning oI
students. This can also aIIect the quality oI student-liIe iI aggravated. What is unIortunate is that most
conditions are leIt under-diagnosed or under-treated because symptoms are oIten discounted by parents as
just allergies.
|15|
The study Iurther noted that aside Irom the loss oI cognitive Iunction in children with
5

moderate to severe AR, this can also cause irritability and Iatigue leading to the inattentiveness and
diIIiculty in concentrating in school. One oI the most important components oI management, according
to the study, is to educate the patient and the Iamily about avoiding the allergens that the children are
allergic to.
Sleep disturbances were caused by nasal congestion/blockade and also Irequent awakenings
during at night due to allergic inIlammation. AR causes sleep disturbances, daytime sleepiness,
absenteeism, 'presenteeism, irritability, restlessness, mood disorders, and an altered social liIe.
'Presenteeism is the inattention, distraction, and lack oI attention oI the students while inside the
classroom due to the symptoms oI AR. Obviously, one oI the main causes oI learning diIIiculty and
school Iailure is the students` inability to concentrate due to untreated ARgiven that it is in Iact one oI
the most common chronic illnesses that hits children and teenagers.
|16|, |19|

Focusing on the building conditions wherein classrooms are situated, a study that concerns
transmission oI airborne diseases was conducted in Peru. Rooms that only had natural measures Ior
encouraging airIlow were compared with mechanically ventilated rooms that were built much more
recently. A comparison was also done between naturally ventilated rooms in old hospitals and naturally
ventilated rooms in newer hospitals. Results showed that natural ventilation had high rates oI air
exchange, with an average oI 28 air changes per hour. 50 year old hospitals had the highest ventilation
with an average oI 40 air changes per hour due to its structure. This rate is Iar higher compared to the 17
air changes per hour in naturally ventilated rooms in modern hospitals, which have lower ceilings and
smaller windows.
|20|
In line with this, a study about the impact oI school building conditions on student absenteeism in
Upstate New York, researchers investigated this by obtaining data Irom the 2005 Building Condition
Survey oI Upstate New York schools with 2005 New York State Education department students
absenteeism data at the individual school level and evaluated associations between building conditions
and absenteeism at or above the 90
th
percentile. As a result, researchers associated absenteeism with
visible molds, humidity, poor ventilation, vermin, building condition problems, and building system or
structural problems related to these conditions. They also saw that schools in lower socioeconomic
districts and schools attended by younger students showed the strongest association between poor
building conditions and absenteeism. With this study, there were some limitations. Some conIounding
variables were the external exposures such as traIIic pollution and exposures Irom a student`s home could
have aIIected this study. In addition, absenteeism due to illness or other reasons could not be
distinguished. The study's ecological design did not allow collection oI inIormation on individual health
outcomes or reasons Ior absenteeism. In conclusion, they Iound associations between student absenteeism
and adverse school building conditions. As a recommendation, Iurther studies should conIirm these
Iindings and prioritize strategies Ior school condition improvements.
|3|




6

Conceptual Framework

Figure 1. Conceptual Iramework oI the research study. The Iocus oI the study is that exposure to air-
conditioning system in the classroom leads to mild severity allergic rhinitis. Exposure to airconditioning
system is aIIected by socioeconomic status because this will determine the type oI school Iacilities
aIIorded by the Iamily to enrol the child into, and environmental Iactors also play a role. The Iactors that
aIIect severity oI AR on the other hand are mainly socioeconomic status which also aIIects education
attained by the student and compliance to treatment. Other Iactors include environmental triggers,
crowding inside the classroom, and the culture and traditions oI the student.

IV. METHODOLOGY
Research Design
The type oI study that the researchers are going to be implementing is a cross-sectional research design.
The researchers deem this the most necessary research design just to see whether or not there is a
relationship between the number oI hours exposed to air-conditioning systems and the exacerbation oI
Allergic Rhinitis. Moreover, this research design is appropriate because the Disease Variable oI the
research, which is Allergic Rhinitis, is not a rare disease (thus eliminating the use oI a case-control study).
However, in doing a cross-sectional study, the researchers must take note oI and control the conIounding
variablesways oI which will be discussed in the latter part oI the description oI the research design.

DeIinition oI Study Population / Study Groups
The study population will be 2
nd
year highschool students in the Philippine setting. From this population,
a sample oI students who have AR will be considered Ior the study.
Source oI Subjects
The sample populations will be gathered Irom select schools in Dasmarias, Cavite, ideally one private
and public school in order to acquire subjects that have exposure to an air conditioned school environment
and one that is not.


7

Operational DeIinition oI Variables
O Dependent Variable - Allergic Rhinitis
Allergic rhinitis (oIten called allergies or hay Iever) occurs when the immune system
overreacts to particles in the air that you breathe. When the immune system attacks the particles in
the body, it causes symptoms such as sneezing and a runny nose. Over the time, allergens may
begin to aIIect you less, and the severity oI the symptoms also decreases.
|21|
It is characterized as
the inIlammation oI nasal passages, usually associated with watery nasal discharge and itching oI
the nose and eyes aIter exposure to the allergen.
Around two-thirds oI people with allergic rhinitis maniIest the symptoms beIore the age oI 30
but the age at which the symptoms occur may vary. Genetics greatly aIIects the chance oI having
allergic rhinitis oI an individual. Usually iI one or both parents have the disease, their oIIspring
will have a high chance oI inheriting the disease. People with allergic rhinitis can also be restricted
by the disease in their day to day activities and this may result to increase in time away Irom
school or work. Also, in the US, millions oI dollars are spent every year Ior doctor services and
medicine Ior treating the chronic illness. Symptoms oI this illness are triggered by many diIIerent
allergens and these usually include plant pollens, molds, dust, and allergens produced by cats or
dogs. The amount oI these allergens is aIIected by the season as the spread oI pollens and spores
are determined by the amount oI wind in a particular season.
|22|

O Independent Variable - Air-conditioning System
According to the Department oI Health oI Hong Kong, sudden change in temperature both
indoor and outdoor may activate the release oI inIlammatory agents. They stated that the room
should be maintained at around 25 degrees Celsius.
|23|

The air conditioner is a common appliance usually Iound in many buildings both private and
public. It is used to cool the air Iound indoors to make the people inside the building more
comIortable. Air conditioners nowadays are not only used Ior cooling the air, some types oI air
conditioners can warm the indoor air especially those that are Iound in places where people
experience the winter season. In addition to their air temperature changing capability, the air
conditioners nowadays are also capable oI Iiltering, disinIecting and dehumidiIying the air to make
the people using the appliance more comIortable that is why the air conditioner is also regarded as
'comIort-making-machine by some people.
|24|

O Confounding Variables:
Allergens are substances or particles that are Ioreign to the body and can cause allergic
reaction in certain people. Pollens, molds, cockroaches, and dusts are examples oI allergens which
can be Iound in the environment. In managing allergies, it is suggested to reduce the level oI
exposure to these allergens.
|27|

According to an article by deShazo and Kemp, the spores coming Irom molds can be a trigger
in releasing the symptoms oI allergic rhinitis. Also, according to them, molds thrives in damp
environments such as air-conditioning vents, water traps, reIrigerator drip trays, shower stalls,
leaky sink and damp basements iI not cleaned regularly and under certain conditions, the growth
oI these organisms can be considerable and exacerbate allergy symptoms.
|25|
Since allergic rhinitis
is diIIicult to cure, the Iocus is on preventing the attack oI the symptoms. Molds are seen as
cotton-like element that is usually in the color oI gray, green, black or white. These molds produce
strong earthy and musty odors, although some are odor-Iree. The smell could be an indication oI
inIection.
|28|

8

Many diIIerent triggers that may cause a student to experience symptoms oI asthma and
allergy are Iound inside a typical classroom. These triggers include the pollens Irom the plants
Iound near or inside a classroom, dust mites and mold spores. The cleanliness oI the room may
also play a Iactor in triggering the allergic reactions. The students themselves may also carry
allergens produced by their pet cats or dogs that may be attached to their clothes and these
allergens can be in contact with the students with asthma or allergy. Chalk dusts are also usually
the causes oI allergic reactions inside the classroom since the teachers usually use chalks Ior
writing on the green boards.
|26|

Chalk dusts are particles produced when a chalk crayon is used to write on chalkboards.
These usually remain suspended in the air because these particles are not so heavy so as a result,
teachers and students usually inhale small amount oI these and become trapped in the mucous
layers oI the throat and upper lungs. This does not usually pose a threat to normal persons because
the accumulated chalk dust is naturally expelled out through coughing and the remaining chalk
dust is saIely absorbed by the body. However, in persons with chronic breathing issues or allergic
rhinitis these chalk dust can irritate their upper respiratory tract and trigger their symptoms and can
be dangerous Ior the person who inhaled the chalk dust.
|29|

Cockroaches are recognized as powerIul indoor allergens. They are among the oldest living
species residing the earth. These creatures are hardy and adaptable that thrives in areas where Iood
and water supplies are plentiIul. They can be Iound around dripping Iaucets and kitchen areas. The
allergen produced by cockroaches is Irom the saliva, body parts and even their digestive enzymes.
These particles become airborne when disturbed by motion in the room.
|27|


Steps to be Undertaken
These are the steps to be done in our procedure to collect data Ior this project:
1. Randomly select Iour (4) High Schools in Dasmarias, Cavite. ClassiIy into with air-
conditioning system` and without air-conditioning system` by contacting the principal oI the selected
schools.
2. Evaluate the classroom conditions oI each school.
The group will visit each high school and evaluate the environmental conditions oI each classroom
that will be part oI the research. An integrated checklist Irom Health Canada and IAQ Tools Ior
Schools
|30|, |31|
will be given to teacher or adviser oI each classroom document and evaluate the
conditions.
3. Screen students Ior allergic rhinitis.
Each student will be screened through a questionnaire, based sections oI the ISAAC questionnaire, to
eliminate those who do not have allergic rhinitis Irom the study group.
|32|
This will help in making
the research study more speciIic to those who have allergic rhinitis and how the classroom conditions
can alleviate or exacerbate their symptoms.
4.
Sections oI the ARIA questionnaire will be given to each student who has AR in which it will ask
them iI their symptoms are better or worse when they are in the classroom and what speciIic
conditions help or exacerbate their condition.
|33|
5. Evaluate each student`s questionnaire.
Each student`s questionnaire will be evaluated to see what particular conditions aIIect the severity oI
their AR. There will also be a particular Iocus on whether having an air-conditioning system present
or not alleviates or worsens each student`s AR symptoms.
9

Schematic Diagram oI the Design

Fig 2. Schematic diagram showing the exposures and the possible outcomes oI the study

Possible Biases and Plans to Control / Minimize these Biases
O Enumeration of all biases/limitations
The study will only Iocus on the role oI ventilation inside the classrooms in the relieI and
exacerbation oI allergic rhinitis among 2
nd
year high school students studying in Dasmarias,
Cavite. It will not include other respiratory diseases and illness that may be aIIected by the
diIIerence in ventilation.
The possible biases in the study are:
O Selection bias
O Expectation bias
O Social Desirability bias (Hawthorne EIIect)
O Plan to minimize these biases in the study
Selection bias may happen when subjects being compared are not similar, and may result to
data that is not representative oI the population oI interest.
|34|
With the use oI proper screening
methods Ior the study population, we will select subjects that are similar in almost all aspects in
order to gather a more representative and comparable data. Randomnization will also be
implemented in the selection oI subjects to minimize this bias.
Expectation bias happens when there is no masking or blinding implemented in the study and
this may inIluence and tarnish the data to be gathered towards the expected or desired outcome.
|34|

To minimize this bias, a high level oI objectivity must be maintained with each oI the members oI
the group oI researchers in the gathering oI data and its analysis.
Social desirability bias or the Hawthorne eIIect may aIIect the interpretation oI the results oI
the study which may bring about data that is not truly representative since the subjects may answer
according to what is acceptable socially or by the norm and not in Iull honesty. To minimize this,
we shall ensure conIidentiality in all data given and we will guarantee the subjects that they will
beneIit as well iI they tell the researchers the truth since it is regarding their condition.

10

Sampling Method
Firstly, in selecting Ior the respondents oI the study, a list oI all the schools in Dasmarinas City, both
public and private, was obtained. Two schools with air conditioning systems will be randomly chosen
Irom the list and two schools without air conditioning systems will also be randomly chosen. Fish bowl
method will be used in selecting Ior both schools. However, beIore selecting Ior the schools, those with
air conditioning systems and those without must be identiIied Iirst. To do this, the principals oI the
schools will be contacted through telephone calls and be politely asked to elicit the presence oI air-
conditioning systems in their classrooms and the number oI second year students they have.
Selection oI Cases
For the selection oI cases, among the students oI the selected schools with air conditioning
systems, random sections per school will be selected via the Iish bowl method . The students oI
the selected sections will be given ISAAC questionnaires Ior screening and selection oI students
with allergic rhinitis.
Selection oI Controls
For the selection oI controls, the same process in the selection oI the cases will be utilized but
instead oI choosing Irom the list schools with air conditioning system, list oI schools without air
conditioning systems will be used.

Fig 3. Schematic diagram oI the method to be employed in selection oI cases and controls in the study.


11

Sample Size
DeIinition oI variables used in the calculations
1. p1
The p1 variable is the estimate oI the sample population Ior the high school students who study in
air-conditioned classrooms that have mild allergic rhinitis.
. p
The p2 variable is the estimate oI the sample population Ior the high school students who study in
non-air-conditioned classrooms that have mild allergic rhinitis.

3. Alpha (o)
Alpha is the probability oI committing a type I error, which means rejecting the null hypothesis
when in Iact the null hypothesis is true. In the study, this is when results show that there is no
association between exposure to air-conditioning system and alleviation oI severity oI AR when
in Iact there is.
. Beta ()
Beta is the probability oI committing a type II error, which means retaining the null hypothesis
when the null is Ialse. In the study, this is when we Iail to reject the null hypothesis even iI there
is suIIicient evidence to state otherwise.
. Direction of Test
The study is a one tailed test because we are leaning towards the result oI which air-conditioning
helps in alleviating the severity oI AR.
Values
p1 30.7
p 13.4
o 0.95
0.80

The p1 and p2 values were based on the Iollowing study:
Mendell, M.J. & Smith, A.H. (1990). Consistent Pattern oI Elevated Symptoms in
Airconditioned OIIice Buildings: A Reanalysis oI Epidemiologic Studies.
American Journal of Public Health. (80) 10.








12

Computation Using a Computer Program (Open Epi)

Figure 3. Inputted values in Open Epi in the computation oI a computer-generated sample size.

Figure 4. Total sample size computed was 202, meaning 101 students will comprise the exposed group
and the other 101 students will be the unexposed group.
13

Data Collection
Method oI Data Collection

The researchers` method oI data collection will primarily include the use oI questionnaires and checklists.
The questionnaires (ISAAC-based) shall Iirst be given to students to screen each whether or not they have
Allergic Rhinitis. AIter screening the students, we shall administer the ARIA questionnaires to classiIy
them according to severity oI their Allergic Rhinitis. The questions are primarily based on the ARIA
classiIication oI severity Ior Allergic Rhinitis. This will enable the researchers to determine whether or
not there is severity oI Allergic Rhinitis among those exposed to air-conditioned non air-conditioned
rooms and to classiIy them as to mild or severe to moderate Allergic Rhinitis.
Moreover, the researchers will also use a checklist to survey the classroom conditions the
students are exposed to. These will include conditions inside and outside oI the room that could possibly
aIIect the students` conditions.

Source oI Data

Sources Ior the researchers` data will primarily come Irom second year high school students oI the
selected schools that will be included in the study. Moreover, observation will also be used to survey the
environmental conditions inside and outside oI the students` classrooms to identiIy possible attributing
Iactors to the trigger and exacerbation oI one`s Allergic Rhinitis.

Data Collection Tool
The researchers` tools will include:
1. ISAAC-based questionnaires to screen Ior Allergic Rhinitis
2. ARIA ClassiIication questionnaire Ior determining the severity oI the students`
Allergic Rhinitis
3. Checklist Ior Classroom Conditions
Please see attached questionnaires and checklist.









14

1. ISAAC QUESTIONNAIRE FOR SCREENING STUDENTS
Study Instruments for 13/1 year olds
Instructions for Completing Questionnaire and Demographic Questions (Section 7.1)
On this sheet are questions about your name, school, and birth dates. Please write your answers to the
Iollowing questions in the space provided.
All other questions require you to tick (check) your answer in a box. II you make a mistake, put a cross in
the box and tick the correct answer. Tick only one option unless otherwise instructed.


SCHOOL:

TODAY`S DATE:
Day Month Year
YOUR NAME:
YOUR AGE: years
YOUR DATE OF BIRTH:
Day Month Year
(Tick all your answers for the rest of the questionnaire)
Are you: MALE FEMALE












15

Core Questionnaire for Allergic Rhinitis (Section 7.3)
All questions are about problems which occur when you DO NOT have a cold or the Ilu.
1 Have you ever had a problem with sneezing, or a runny, or
blocked nose when you DID NOT have a cold or the Ilu?
.Yes
.No
IF YOU HAVE ANSWERED 'NO PLEASE SKIP TO QUESTION 4.
2 In the past 12 months, have you had a problem with sneezing,
or a runny, or blocked nose when you DID NOT have a cold
or the Ilu?
.Yes
.No
IF YOU HAVE ANSWERED 'NO PLEASE SKIP TO QUESTION 4.
3 In the past 12 months, has this nose problem been
accompanied by itchy-watery eyes?
.Yes
.No
4 Have you ever had hay Iever? .Yes
.No
















16

PALATANUNGANG ISAAC (Filipino version of the ISAAC Questionnaire)
Lahat ng mga katanungan dito ay ukol sa mga problemang nangyayari kapag ika`y walang sipon o
trangkaso.
1. Nagkaroon na ba kayo ng problema sa pagbahing, o di kaya`y
tumutulo, o baradong ilong nang kayo ay WALANG sipon o trangkaso.

Kapag kayo po ay sumagot ng HINDI, mangyari po lamang ay
tumungo na kayo sa ika-apat na katanungan

.Yes
.No

2. Sa loob ng nakaraang labing dalawang buwan, nagkaroon po ba kayo
ng problema sa pagbahing, o di kaya`y tumutulo o baradong ilong nang
kayo ay walang sipon o trangkaso?

Kapag kayo po ay sumagot ng HINDI, mangyari po lamang ay
tumungo na kayo sa ika-apat na katanungan.

.Yes
.No

3. Sa loob ng nakaraang labing dalawang buwan, ang problema po ninyo
sa ilong ay nasabayan ng makati at maluha-luhang mata?

.Yes
.No

4. Nagkaroon na po ba kayo ng 'hay Iever?

.Yes
.No















17

. ARIA QUESTIONNAIRE
1. What symptoms do you have?
(Answer 'Yes` for any of the symptoms listed below that apply. Answer `No` for all that do not.)
Watery runny nose .Yes .No
Sneezing (especially violent and in bouts) .Yes .No
Nasal obstruction (Ieeling oI being unable to breathe through your nose) .Yes .No
Itchy nose .Yes .No
Watery, red, itchy eyes .Yes .No

. How long do your symptoms last?
(Answer 'Yes` or 'No` for each time frame below.)
More than Iour days a week .Yes .No
More than Iour weeks in a row .Yes .No

3. How do your symptoms affect you?
(Answer 'Yes` for any of the symptoms listed below that apply. Answer `No` for all that do not.)
My symptoms disturb my sleep. .Yes .No
My symptoms restrict my daily activities (sports, leisure, etc.) .Yes .No
My symptoms restrict my participation in school or work. .Yes .No
My symptoms are troublesome to me. .Yes .No

. How much do your symptoms bother you?
(On a scale of 0 to 10, with 0 being 'Not at all` and 10 as 'Jery much`, indicate how much your symptoms bother you Tick only
one.)
. 0 . 4 . 8
. 1 . 5 . 9
. 2 . 6 . 10
. 3 . 7







18

3. CHECKLIST FOR CLASSROOM CONDITIONS

Checklist for the presence of MOLDS (http://www.moldunit.com/mold-detection.html)
.Yes .No 1. Presence oI water leaks coming Irom either rain or air-conditioning units apparent on
the ceiling, walls and pipes or stagnant water.
.Yes .No 2. Wet cellulose materials such as paper, cardboard, ceiling tiles and wood products.
.Yes .No 3. Appearance oI a cottony, velvety, granular or leathery like dirt (in any shade oI color)
near or within the area where there are water leaks.
.Yes .No 4. Inspect walls, under carpeting, under cabinets and air ducts Ior hidden molds.

Checklist for the presence of COCKROACHES (http://www.ehow.com/how7744440tell-
roaches.html) (http://www.roebourne.wa.gov.au/Assets/environment/hs-
002520cockroach20management.pdI)
.Yes .No 1. Presence oI dripping Iaucets and bathrooms.
.Yes .No 2. Presence oI eggs oI roaches, dead roaches, insect parts or Ieces (black gritty substance,
pepper-like) under the cabinets or behind walls and appliances, and sight oI cockroaches
themselves.
.Yes .No 3. Evidence oI holes Irom chewing such as paper and cardboards.

Checklist for the presence of HOUSE DUST
.Yes .No 1. Presence oI curtains, pillows, carpets
.Yes .No 2. Presence oI dust when you touch or rub with your hand the materials mentioned
above.
.Yes .No 2. Presence oI dust above the tables, chairs, window sills, and the Iloor.

Checklist for the presence of CHALK DUST
.Yes .No 1. Presence oI chalk (Ior writing on the board) and speciIy iI it is dustless or not.
.Yes .No 2. Presence oI chalk dust in corners oI the board and on the board eraser.
.Yes .No 3. Presence oI a wet rag Ior cleaning the chalk board.
.Yes .No 4. Presence oI a box Ior cleaning the board eraser.







19

V. BIBLIOGRAPHY
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|Abstract|. Allergy Asthma Proc. 22(4): 185-9. Retrieved July 8, 2011 Irom:
http://www.medscape.com/medline/abstract/11552666.
|2| Pawankar, R., Baena-Cagnani, C.E., Bousquet, J., Canonica, G.W., Cruz, A.A., Kaliner, M.A. &
Lanier, B.Q. (2008). State oI the World Allergy Report 2008: Allergy and Chronic Respiratory
Distress. World Allergy Organization Journal, Supplement 1.
|3| Simons, E., Hwang, S., Fitsgerald, E., Keilb, C. & Lin, S. (2009). The Impact oI School Building
Conditions on Student Absenteeism in Upstate New York. 100 (9). Research and Practice.
|4| Blaiss, MS. Allergic rhinitis and impairment issues in schoolchildren: a consensus report. Current
Medical Research and Opinion. 2004 Dec; 20(12):1937-52. From:
http://www.redorbit.com/news/health/131029/allergicrhinitisandimpairmentissuesinschool
childrenaconsensusreport/index.html
|5| Meltzer, E.O. (1998). Treatment Options Ior the Child with Allergic Rhinitis. Clinical Pediatrics. Jan
1998; 37, 1; ProQuest Research Library. Accessed July 7, 2011.
|6| Alm B, Gokso r E, Thengilsdottir H, Pettersson R, Mo llborg P, Norvenius G, Erdes L, A berg N,
Wennergren G. Early protective and risk Iactors Ior allergic rhinitis at age 4 years. Pediatric
Allergy and Immunology 2011; 22: 398404. Retrieved July 22, 2011 Irom
http://onlinelibrary.wiley.com/doi/10.1111/j.1399-3038.2011.01153.x/pdI
|7| Nakagomi T, Itaya H, Tominaga T, et al. (1994). Is atopy increasing? Lancet 1994,343.1212.
Retrieved July 22, 2011 from http.//www.ncbi.nlm.nih.gov/pubmed/7903758
|8| Hajat S, et al. Association between air pollution and daily consultations with general practitioners Ior
allergic rhinitis in London, United Kingdom. American Journal of Epidemiology (2001) 153 (7):
704-714. Retrieved July 22, 2011 Irom http://aje.oxIordjournals.org/content/153/7/704.Iull
|9| Busse, P. (2010). Allergic rhinitis. Medlineplus. Retrieved July 16, 2011, Irom
http://www.nlm.nih.gov/medlineplus/ency/article/000813.htm.
|10| Togias, A. (2004). Unique mechanistic Ieatures oI allergic rhinitis. Journal of allergy and clinical
immunology. Retrieved July 16, 2011, Irom
http://www.sciencedirect.com/science/article/pii/S0091674900093143.
|11| Cauwenberge, et. al. (2004). Epidemiology oI Allergic Rhinitis. The UCB Institute oI Allergy,
Brussels.
|12| Settipane, R.J., Hagy, G.W., Settipane, G.A.(1994). Long-term risk Iactors Ior developing asthma
and allergic rhinitis: a 23-year Iollow-up study oI college students. Allergy Proc. 15: 21-25.
|13| Kutintara, Benjamas. "Home Environments and Allergen Avoidance Practices in a Hot, Humid
Climate." Virginia Polytechnic Institute and State University, 2002. United States -- Virginia:
ProQuest Dissertations & Theses (PQDT). Web. 17 July 2011.
|14| Health risks in the classroom: children with asthma and allergies need to take special precautions at
school. (2007). American Academy oI Asthma, Allergies, and Immunology. Retrieved July 15,
2011 Irom http://www.kidneeds.com/diagnosticcategories/articles/classrisks02.htm
|15| Mahoney, D. (2005). Allergic rhinitis hits hard in the classroom. Retrieved July 16, 2011 Irom The
CBS Interactive Business Network website:
http://Iindarticles.com/p/articles/mihb4384/is339/ain29168995/pg2/?tagmantleskin;conte
nt
20

|16| Jauregui, I. et al. (2009). Allergic rhinitis and school perIormance. J Investig Allergol Clin Immunol.
19, 1: 32-39. Retrieved July 16, 2011 Irom http://www.jiaci.org/issues/vol19s1/6.pdI
|17| Asher MI, MonteIort S, Bjorksten B, Lai CK, Stachan DP, Weiland SK et al. Worldwide time trends
in the prevalence oI symptoms oI asthma, allergic rhinoconjunctivitis, and eczema in childhood:
ISAAC Phases One and Three repeat multi-country crosssectional surveys. Lancet 2006; 368:733-
743. Retrieved July 16, 2011 Irom http://www.ncbi.nlm.nih.gov/pubmed/16935684
|18| Wilken JA, Berkowitz R, Kane R. Decrements in vigilance and cognitive Iunctioning associated with
ragweed-induced allergic rhinitis. Ann Allergy Asthma Immunol 2002;89:372380. Retrieved July
16, 2011 Irom http://www.sciencedirect.com/science/article/pii/S1081120610620388
|19| Karande S, Kulkarni M. Poor school perIormance. Indian J Pediatr 2005; 72(11):961-967. Retrieved
July 16, 2011 Irom http://www.ncbi.nlm.nih.gov/pubmed/16391452
|20| Siriaksorn, S. (2011). Allergic rhinitis and immunoglobulin deIiciency in preschool children with
Irequent upper respiratory illness. PubMed. 29(1):73-7. Retrieved July 8, 2011 Irom
http://www.ncbi.nlm.nih.gov/pubmed/21560491.
|21| Healthwise StaII, 'Allergic Rhinitis, In: Thompson, E.G. MD, Nelson, H.S. MD, editor, 'Allergic
Rhinitis |cited 2011 July 31| Available Irom: http://www.webmd.com/allergies/tc/allergic-
rhinitis-overview
|22| Allergic rhinitis. (2010). Health encyclopedia diseases and conditions.Retrieved July 10, 2011,
Irom http://www.healthscout.com/ency/68/208/main.html.
|23| Retrieved on July 30, 2011 Irom
http://www.studenthealth.gov.hk/english/health/healthophp/healthophpnos.html
|24| Air conditioner. (2009). Air conditioning and refrigeration information.Retrieved July 30, 2011,
Irom http://www.air-conditioning-and-reIrigeration.com/air-conditioner.html.
|25| deShazo R., Patient InIormation: Trigger avoidance in allergic rhinitis. Retrieved on July 30, 2011
Irom http://www.uptodate.com/contents/patient-inIormation-trigger-avoidance-in-allergic-rhinitis
|26| Health risks in the classroom: children with asthma and allergies need to take special precautions at
school. Retrieved July 30, 2011, Irom
http://www.kidneeds.com/diagnosticcategories/articles/classrisks01.htm.
|27| Stppler, M.C., MD. 'Indoor Allergens In: Shiel, W.C. Jr., MD. FACP.FACR., editor, |cited 8
August 2011| Available Irom http://www.medicinenet.com/indoorallergens/article.htm
|28| Oliver, S., 'Mold Detection How to Detect Toxic Mold in your Home? |cited 8 August 2011|
Available Irom http://ezinearticles.com/?Mold-Detection---How-to-Detect-Toxic-Mold-in-Your-
Home?&id2589917
|29| Pollick, M. (2011). Is chalk dust harmIul? Wise geek. clear answers for common questions.
Retrieved August 8, 2011, Irom http://www.wisegeek.com/is-chalk-dust-harmIul.htm.
|30| Classroom Checklist (2007). Health Canada |Website|. Available Irom: http://www.hc-sc.gc.ca/ewh-
semt/pubs/air/toolsschool-outilsecoles/classroom-salleclasse-eng.php
|31| IAQ tools for Schools. North Hunderton-Voorhees Regional District High School |Website|.
Available Irom: http://www.nhvweb.net/VHS/Math/ABlaustein/toolsIorschools/teacher.pdI
21

|32|ISAAC Questionnaire. International Study oI Asthma and Allergies in Childhood,|Website|. 2011
|cited 2011 August 8|. Available Irom
http://isaac.auckland.ac.nz/phases/phasethree/corequestionnaire.pdI.
|33| ARIA Questionnaire. Allergic Rhinitis and its Impact on Asthma |Website|. 2011 |cited 2011 July
30|. Available Irom http://www.whiar.org/docs/ARIAOnlineQuestionnaireGuidewm3-
8sp.pdI
|34| Hartman, J.M., Forsen, J.W., Wallace, M.S., Neely, J.G. (2002). Tutorials in clinical research: Part
IV: Recognizing and controlling bias. Laryngoscope, 112, 23-31.





































22

VI. APPENDICES
APPENDIX A
Excerpt Irom the study 'Consistent Pattern oI Elevated Symptoms in Airconditioned OIIice Buildings: A
Reanalysis oI Epidemiologic Studies by Mendell & Smith (1990) in which the values were obtained.




APPENDIX B -Letter to the School Principals
23

De La Salle lealth Science Institute - College o Medicine
Dasmarinas, Caite 4114


uaLe

name of rlnclpal
oslLlon
name of School
Address

uear Slr/Ma'am
CreeLlngs!
We Second ?ear Medlcal sLudenLs of ue La SallePealLh Sclences lnsLlLuLe College of Medlclne are happy Lo
lnform you LhaL your school has been selecLed Lo Lake parL ln our research sLudy ln llne wlLh Lhls we would
llke Lo ask your permlsslon Lo lnclude your school ln our sLudy
1he research sLudy ls abouL Lhe effecLs of exposure Lo alrcondlLloned rooms and non alr
condlLloned rooms on Lhe severlLy of Allerglc 8hlnlLls among second year hlgh school sLudenLs ln uasmarlnas
ClLy CavlLe ln llne wlLh Lhls we are asklng for your klnd conslderaLlon Lo leL us lnclude your school ln our
research endeavor
Cur sLudy wlll lnclude Lhe surveylng and screenlng of second year hlgh school sLudenLs for Allerglc
8hlnlLls and surveylng Lhe envlronmenLal condlLlons ln whlch sLudenLs are exposed Lo boLh lnslde and ouLslde
of Lhe classroom
We can assure you LhaL all lnformaLlon wlll be kepL confldenLlal and LhaL Lhese bodles of lnformaLlon
wlll be used solely for Lhe purpose of Lhe sLudy lf you have furLher quesLlons or querles wlLh regard Lo our
requesL please feel free Lo conLacL us Lhrough Lhe number provlded below
We are hoplng for your klnd conslderaLlon 1hank you very much

?ours ln SL La Salle

!oshua A Arcalra
Croup Leader (09139084464)
nC1Lu 8?

ur !ovllla M Abong
Croup recepLor
ur lsaac A llano
2
nd
?ear CoordlnaLor CommunlLy
Medlclne
ur ChrlsLlne S 1lnlo
Chalr lamlly and CommunlLy
Medlclne ueparLmenL
23

APPENDIX C - Informed Consent Letter for the Parents of the Students (English Version)
October 12, 2011
ear Parents,
name is Joshua Arcaira. am a second ear medical student at e La Salle Health Sciences
nstitute and leader of our group in Famil and Communit edicine conducting a stud entitled,
"Exposure to Air-conditioning Sstems in Classrooms Leads to ild Severit of Allergic Rhinitis in Second
Year High School Students of Selected Schools in the Cit of asmarias, Cavite: A Cross-Sectional
Stud. Our stud will have the following objectives:

General Objective: To determine if the exposure to the air-conditioning sstem affects the severit
of Allergic Rhinitis in second ear high school students of selected schools in the Cit of
asmarias, Cavite.

Specific Obejectives:
1. To identif the prevalence of Allergic Rhinitis among second ear high school students of
selected schools in the Cit of asmarias, Cavite based on their exposure to air-conditioned
rooms.
2. To identif the prevalence of Allergic Rhinitis among second ear high school students of
selected schools in the Cit of asmarias, Cavite based on their exposure to non air-conditioned
rooms.
3. To determine the severit of Allergic Rhinitis according to ARA classifications.
4. To identif the risk factors of Allergic Rhinitis present in the classroom or school, such as the
presence of molds, chalk, dust, and cockroaches.
5. Compare the severit of Allergic Rhinitis in students who are exposed to air-conditioned
classrooms and those who are not exposed to air-conditioned classrooms.

Since our stud requires the participation of second ear high school students with Allergic
Rhinitis, our child has been chosen to be included as a participant in our research project.
With our permission, will ask our child to complete a short four-item questionnaire that would
take no longer than 10 minutes to answer to assess the severit of our child's Allergic Rhinitis. Your
child's participation in this stud is completel voluntar and will not affect his/her grades in an
wa. There are no known risks involved in this stud and, as a benefit, ou and our child will be able to
learn more about the severit of our child's Allergic Rhinitis. To protect our child's confidentialit, the
questionnaire will not be shared with anone, including school authorities, other parents, or an other
students, unless required b law. Your child ma quit this stud at an time b writing "Stop or " do not
wish to participate on the questionnaire. The questionnaire given will be kept b our preceptor, r. Jovilia
Abong, and b m groupmates and me.
This letter will serve as a consent form for our child's participation and will be kept in the Famil
and Communit edicine epartment at the College of edicine at e La Salle Health Sciences nstitute.
f ou have an questions or concerns about this stud, please feel free to approach me or our
advisor. You ma contact me at 09159084464. Thank ou for our kind consideration.
Please have our child return this form to his/her class advisor b (date).
Sincerel ours,

Joshua Arcaira
24

Agreement
Statement of Consent
read the above consent form. The nature, demands, risk, and benefits of the project have been
explained to me. am aware that have the opportunit to ask questions about this research.
understand that ma withdraw m consent and discontinue m child's participation at an time without
penalt.

Student's Name (Please Print) Date Parent's Name and Signature

certif that have explained to the above named individual the nature and purpose, the potential benefits
and possible risks associated with participation in this research stud. have answered all questions that
have been raised b this parent. have provided the participant's legal guardian with a cop of this
signed consent form.

Student Researcher Date















25

APPENDIX D - Informed Consent Letter for the Parents of the Students (Filipino Version)
AALAMANG PAGPAYAG NA SULAT
Oktubre 12, 2011
ahal kong mga agulang:
Ang pangalan ko po a Joshua Arcaira. Ako po a nasa pangalawang taon ng kursong
edisina sa e La Salle Health Sciences nstitute at lider ng aming grupo sa Famil and Communit
edicine. Kami po a nagsasagawa ng isang pag-aaral na pinamagatang ""Exposure to Air-conditioning
Sstems in Classrooms Leads to ild Severit of Allergic Rhinitis in Second Year High School Students
of Selected Schools in asmarias Cit, Cavite: A Cross-Sectional Stud. Ang aming pag-aaral a
maroong mga sumusunod na launin:

Pangkalahatang Launin: Upang matuko kung ang pagkakalantad sa silid-aralan na ma air-
condition a nakakaapekto sa kalubhaan ng Allergic Rhinitis sa mga mag-aaral na nasa
ikalawang antas ng sekundara sa mga napiling paaralan sa Lungsod ng asmarias, Cavite.

Tiak na mga Launin:

1. Upang malaman ang lawak ng pagkakaroon ng Allergic Rhinitis sa mga mag-aaral na nasa
ikalawang antas ng sekundara sa mga napiling paaralan sa Lungsod ng asmarias, Cavite
aon sa kanilang pagkakalantad sa air-conditioned na silid-aralan.
2. Upang malaman ang lawak ng pagkakaroon ng Allergic Rhinitis sa mga mag-aaral na nasa
ikalawang antas ng sekundara sa mga napiling paaralan sa Lungsod ng asmarias, Cavite
aon sa kanilang pagkakalantad sa mga silid-aralan na walang air-condition.
3. Upang malaman ang kalubhaan ng Allergic Rhinitis aon sa klasipikason ng ARA.
4. Upang malaman ang mga kondison sa loob ng silid-aralan na maaaring magdulot ng
Allergic Rhinitis tulad ng lumot, tisa/eso(chalk), alikabok at ipis.
5. hambing ang kalubhaan ng Allergic Rhinitis sa ma mag-aaral na lantad sa air-conditioned na
ma silid-aralan at sa mga mag-aaral na hindi lantad sa air-conditioned na silid-aralan.

Sapagkat ang aming pagsasaliksik a nangangailangan ng partisipason ng mga mag-aaral sa
ikalawang antas ng sekundara na maroong Allergic Rhinitis, ang inong anak a napili namin upang
maging kalahok sa aming pananaliksik.

Sa inong pahintulot, humihiling po ako sa inong anak na kumpletuhin ang isang maikling
palatanungan na binubuo ng apat na tanong lamang at ang pagsagot nito a hindi hihigit sa sampung
minute upang matuko ang kalubhaan ng Allergic Rhinitis ng inong anak. Ang paglahok ng inong anak
a kusang-loob at hindi makakaapekto sa kanang marka sa anumang paraan. Sinisiguro po na naming
walang kaakibat na panganib ang pakikilahok sa pag-aaral na ito at bilang benepiso, malalaman nio rin
po at ng inong anak ang kalagaan ng kanang Allergic Rhinitis. Para mapanatili ang pagiging
kompidensial ng mga kaalamang ibabahagi sa amin ng inong anak, ang palatanungan a hindi
kailanman ibibiga sa sinumang nanunungkulan sa paaralan, sa ibang mga magulang at ang iba pang
mga mag-aaral, maliban kung kinakailangan ng batas. aaari pong itigil ng inong anak ang pakikilahok
sa pag-aaral sa anumang oras sa pamamagitan ng pagsulat lamang sa palatanungan ng "Hinto o "Hindi
ko nais na lumahok. Ang mga palatanungan na ito a itatago ng aming preceptor na si r. Jovilia
Abong, maging ako at aking mga kasama ko sa grupo.
Ang sulat na ito a nagsisilbing kaalamang pagpaag na sulat para sa pakikilahok ng inong
anak at itatago sa Famil and Communit edicine epartment ng College of edicine sa e La Salle
Health Sciences nstitute.
26

Kung maroon kang mga katanungan ukol sa pag-aaral na ito, huwag kang mag-alinlangang
makipag-usap sa akin o sa iong tagapao sa klase. aaari mo akong tawagan o i-text sa numerong
09159084464. araming salamat po sa inong pag-unawa at pagpapahintulot.
angari lamang po na ibalik ng inong anak ang sulat na ito sa tagapao sa klase sa (petsa).
Lubos na gumagalang,
Joshua Arcaira

asunduan
Nabasa ko ang kaalamang pagpaag na sulat. Ang mga detale, pangangailangan, panganib at
benepiso ng proektong ito a naipaliwanag sa akin. Alam ko na ako a maaaring magtanong ukol sa
pananaliksik na ito. Naiintindihan ko na maaari kong alisin ang aking pagpaag at ihinto ang pakikilahok
ng aking anak sa anumang oras nang walang parusa.

Pangalan ng Mag-aaral (paki-print) Petsa Pangalan at Pirma ng Magulang

pinaliwanag ko ang detale, dahilan, benepiso at mga posibleng panganib sa pakikilahok sa
pananaliksik na ito. Nasagot ko lahat ng mga katanungan ng magulang na ito. Binigan ko ang legal na
tagabanta ng kalahok ng kopa ng pirmadong kaalamang pagpaag na sulat.


Mag-aaral na Tagapagsaliksik Petsa













27

APPENDIX E - Informed Assent Letter for the Students (English Version)
NFORMED ASSENT LETTER
October 12, 2011
ear Student:
name is Joshua Arcaira. am a second ear medical student at e La Salle Health Sciences
nstitute and leader of our group in Famil and Communit edicine conducting a stud entitled,
"Exposure to Air-conditioning Sstems in Classrooms Leads to ild Severit of Allergic Rhinitis in Second
Year High School Students of Selected Schools in asmarias Cit, Cavite: A Cross-Sectional Stud.
Our stud will have the following objectives:

General Objective: To determine if the exposure to the air-conditioning sstem affects the severit
of Allergic Rhinitis in second ear high school students of selected schools in the Cit of
asmarias, Cavite.

Specific Obejectives:
1. To identif the prevalence of Allergic Rhinitis among second ear high school students of
selected schools in the Cit of asmarias, Cavite based on their exposure to air-conditioned
rooms.
2. To identif the prevalence of Allergic Rhinitis among second ear high school students of
selected schools in the Cit of asmarias, Cavite based on their exposure to non air-conditioned
rooms.
3. To determine the severit of Allergic Rhinitis according to ARA classifications.
4. To identif the risk factors of Allergic Rhinitis present in the classroom or school, such as the
presence of molds, chalk, dust, and cockroaches.
5. Compare the severit of Allergic Rhinitis in students who are exposed to air-conditioned
classrooms and those who are not exposed to air-conditioned classrooms.

Since our stud requires the participation of second ear high school students with Allergic
Rhinitis, ou have been chosen to be included as a participant in our research project.
kindl ask that ou complete a short four-item questionnaire that would take not longer than 10
minutes to answer to assess the severit of our allergic rhinitis. Your parent(s) or legal guardian(s) have
alread given permission for ou to be a part of this stud, but if ou do not wish to participate, ou ma
choose not to. Your participation in this stud will not affect our grades in an wa. There are no known
risks involved in this stud and ou will be able to learn more about the severit of our Allergic Rhinitis.
To protect our confidentialit, the questionnaire will not be shared with anone, including school
authorities, our parents, or an other students, unless required b law. You ma quit this stud at an
time b writing "Stop or " do not wish to participate on the questionnaire. The questionnaire given will be
kept b our preceptor, r. Jovilia Abong and b m groupmates and me.
f ou have an questions or concerns about this stud, please feel free to approach me or our
class advisor. You ma also contact me at 09159084464. Thank ou for our kind consideration.
Sincerel ours,

Joshua Arcaira

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Agreement
agree to participate in this research project and have received a cop of this form.

Student's Name (Please Print) Date Student's Signature

have explained to the above named individual the nature and purpose, benefits and possible risks
associated with participation in this research. have answered all questions that have been raised and
have provided the participant with a cop of this form.

Student Researcher Date



















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APPENDIX F - Informed Assent Letter for the Students (Filipino Version)
AALAMANG PAGPAYAG NA SULAT
Oktubre 12, 2011
ahal kong ag-aaral:
Ang pangalan ko a Joshua Arcaira. Ako a nasa pangalawang taon ng kursong edisina sa e
La Salle Health Sciences nstitute at lider ng aming grupo sa Famil and Communit edicine na
nagsasaliksik sa isang pag-aaral na pinamagatang ""Exposure to Air-conditioning Sstems in Classrooms
Leads to ild Severit of Allergic Rhinitis in Second Year High School Students of Selected Schools in
asmarias Cit, Cavite: A Cross-Sectional Stud. Ang aming pag-aaral a maroong mga sumusunod
na launin:

Pangkalahatang Launin: Upang matuko kung ang pagkakalantad sa silid-aralan na ma air-
condition a nakakaapekto sa kalubhaan ng Allergic Rhinitis sa mga mag-aaral na nasa
ikalawang antas ng sekundara sa mga napiling paaralan sa Lungsod ng asmarias, Cavite.

Tiak na mga Launin:

6. Upang malaman ang pagkakaroon ng Allergic Rhinitis sa mga mag-aaral na nasa ikalawang
antas ng sekundara sa mga napiling paaralan sa Lungsod ng asmarias, Cavite aon sa
kanilang pagkakalantad sa air-conditioned na silid-aralan.
7. Upang malaman ang pagkakaroon ng Allergic Rhinitis sa mga mag-aaral na nasa ikalawang
antas ng sekundara sa mga napiling paaralan sa Lungsod ng asmarias, Cavite aon sa
kanilang pagkakalantad sa mga silid-aralan na walang air-condition.
8. Upang malaman ang kalubhaan ng Allergic Rhinitis aon sa klasipikason ng ARA.
9. Upang malaman ang mga kondison sa loob ng silid-aralan na maaaring magdulot ng
Allergic Rhinitis tulad ng lumot, tisa/eso(chalk), alikabok at ipis.
10. hambing ang kalubhaan ng Allergic Rhinitis sa ma mag-aaral na lantad sa air-conditioned na
ma silid-aralan at sa mga mag-aaral na hindi lantad sa air-conditioned na silid-aralan.

Sapagkat ang aming pagsasaliksik a nangangailangan ng partisipason ng mga mag-aaral sa
ikalawang antas ng sekundara na maroong Allergic Rhinitis, ikaw a napili namin upang maging
kalahok sa aming pananaliksik.

Ako a humihiling sa io na sagutan ang isang maikling palatanungan na binubuo ng apat na
katanungan lamang at ang pagsagot nito a hindi tatagal ng higit sa sampung minute upang malaman
natin ang kalagaan ng iong Allergic Rhinitis. Ang iong mga magulang o legal na tagapag-alaga a
nagbiga na ng pahintulot para sa io upang lumahok sa pag-aaral ngunit maaari kang hindi sumali kung
iong nanaisin. Ang iong pagsali sa pag-aaral na ito a hindi makakaapekto sa iong marka sa anumang
paraan. Walang anumang panganib ang nakaakibat sa pag-aaral na ito at malalaman mo rin mula rito
ang kalubhaan ng iong Allergic Rhinitis. Upang mapanitili ang pagiging kumpidensal ng impormasong
ibabahagi mo sa amin, ang palatanugnan a hindi kailan man ibabahagi sa sinuman sa mga
namamahala ng inong paaralan, ang iong mga magulang at ang iba pang mga mag-aaral, maliban
kung kakailanganin ng batas. aaari mong itigil ang pagsali sa pag-aaral sa anumang oras sa
pamamagitan ng pagsulat lang sa palatanungan ng "Hinto o "Hindi ko nais na lumahok. Ang mga
palatanungan na ito a itatago ko at aking mga kagrupo maging ang aming preceptor na si r. Jovilia
Abong.

30

Kung maroon kang mga katanungan ukol sa pag-aaral na ito, huwag kang mag-alinlangang makipag-
usap sa akin o sa iong tagapao sa klase. aaari mo akong tawagan o i-text sa numerong
09159084464. araming salamat sa iong pag-unawa.
Lubos na gumagalang,
Joshua Arcaira

asunduan
Sumasang-aon ako na lumahok sa proektong ito ng pananaliksik at ako a nakatanggap ng
isang kopa ng form na ito.

Pangalan ng Mag-aaral (paki-print) Petsa Pirma ng Mag-aaral

pinaliwanag ko sa pinangalanang indibidwal ang pinagmulan at launin, mga benepiso at posibleng
panganib nakaugna sa pakikilahok sa pananaliksik na ito. Sinagot ko ang lahat ng mga katanungan na
inilahad at binigan ko ang kalahok ng isang kopang form na ito.


Mag-aaral na Tagapagsaliksik Petsa