Multiple Threats to Child Health from Fossil Fuel Combustion: Impacts of Air Pollution and Climate Change

A methodological pipeline to generate an epigenetic marker of prenatal exposure to air pollution indicators

A barrier in the children's environmental health field has been the lack of early-warning systems to identify risks of childhood illness and developmental disorders. We aimed to develop a methodology to identify an accessible biomarker measured in a small amount of blood to distinguish newborns at elevated risk from a toxic prenatal exposure, using air pollutants as a case study. Because air pollutants are associated with altered DNA methylation, we developed a pipeline using DNA methylation signatures measured in umbilical cord blood, which could be used as predictors of prenatal exposure. We used air pollution indicators, including modelled trimester-specific and pregnancy average NO₂ and PM_2.5, and DNA methylation signatures from Illumina arrays measured in two New York City-based longitudinal birth cohorts from the Columbia Centre for Children's Environmental Health. We developed a screening plus three-part pipeline that incorporates selection, testing, and validation to identify whether DNA methylation can be used to predict exposure to prenatal air pollution indicators, NO₂ and PM_2.5. Applying this pipeline, we found that cord blood DNA methylation could be used to predict high vs. low average pregnancy NO₂ (AUC = 0.60, 95% CI: 0.52-0.68, with validation AUC = 0.60). Similar results were found for high vs. low third trimester NO₂. In this proof of concept study using air pollutants as an example, we provide an approach (with a generalizable analytic pipeline) that can be used for prediction of prenatal exposure to contaminants. This approach has potential to identify children at risk of developmental disorders and illness resulting from prenatal exposure.

Health and economic impact of air pollution in the states of India: the Global Burden of Disease Study 2019

BACKGROUND

The association of air pollution with multiple adverse health outcomes is becoming well established, but its negative economic impact is less well appreciated. It is important to elucidate this impact for the states of India.

METHODS

We estimated exposure to ambient particulate matter pollution, household air pollution, and ambient ozone pollution, and their attributable deaths and disability-adjusted life-years in every state of India as part of the Global Burden of Disease Study (GBD) 2019. We estimated the economic impact of air pollution as the cost of lost output due to premature deaths and morbidity attributable to air pollution for every state of India, using the cost-of-illness method.

FINDINGS

1·67 million (95% uncertainty interval 1·42-1·92) deaths were attributable to air pollution in India in 2019, accounting for 17·8% (15·8-19·5) of the total deaths in the country. The majority of these deaths were from ambient particulate matter pollution (0·98 million [0·77-1·19]) and household air pollution (0·61 million [0·39-0·86]). The death rate due to household air pollution decreased by 64·2% (52·2-74·2) from 1990 to 2019, while that due to ambient particulate matter pollution increased by 115·3% (28·3-344·4) and that due to ambient ozone pollution increased by 139·2% (96·5-195·8). Lost output from premature deaths and morbidity attributable to air pollution accounted for economic losses of US$28·8 billion (21·4-37·4) and $8·0 billion (5·9-10·3), respectively, in India in 2019. This total loss of $36·8 billion (27·4-47·7) was 1·36% of India's gross domestic product (GDP). The economic loss as a proportion of the state GDP varied 3·2 times between the states, ranging from 0·67% (0·47-0·91) to 2·15% (1·60-2·77), and was highest in the low per-capita GDP states of Uttar Pradesh, Bihar, Rajasthan, Madhya Pradesh, and Chhattisgarh. Delhi had the highest per-capita economic loss due to air pollution, followed by Haryana in 2019, with 5·4 times variation across all states.

INTERPRETATION

The high burden of death and disease due to air pollution and its associated substantial adverse economic impact from loss of output could impede India's aspiration to be a $5 trillion economy by 2024. Successful reduction of air pollution in India through state-specific strategies would lead to substantial benefits for both the health of the population and the economy.

FUNDING

UN Environment Programme; Bill & Melinda Gates Foundation; and Indian Council of Medical Research, Department of Health Research, Ministry of Health and Family Welfare, Government of India.

Utilization of Deep Eutectic Solvents to Reduce the Release of Hazardous Gases to the Atmosphere: A Critical Review

The release of certain gases to the atmosphere is controlled in many countries owing to their negative impact on the environment and human health. These gases include carbon dioxide (CO2), sulfur oxides (SOx), nitrogen oxides (NOx), hydrogen sulfide (H2S) and ammonia (NH3). Considering the major contribution of greenhouse gases to global warming and climate change, mitigation of these gases is one of the world's primary challenges. Nevertheless, the commercial processes used to capture these gases suffer from several drawbacks, including the use of volatile solvents, generation of hazardous byproducts, and high-energy demand. Research in green chemistry has resulted in the synthesis of potentially green solvents that are non-toxic, efficient, and environmentally friendly. Deep eutectic solvents (DESs) are novel solvents that upon wise choice of their constituents can be green and tunable with high biocompatibility, high degradability, and low cost. Consequently, the capture of toxic gases by DESs is promising and environmentally friendly and has attracted much attention during the last decade. Here, we review recent results on capture of these gases using different types of DESs. The effect of different parameters, such as chemical structure, molar ratio, temperature, and pressure, on capture efficiency is discussed.

Place of food cooking is associated with acute respiratory infection among under-five children in Ethiopia: multilevel analysis of 2005-2016 Ethiopian Demographic Health Survey data

Background

Globally, acute respiratory infections are among the leading causes of under-five child mortality, especially in lower-income countries; it is associated with indoor exposure to toxic pollutants from solid biomass fuel. In Ethiopia, 90% of the population utilizes solid biomass fuel; respiratory illness is a leading health problem. However, there is a paucity of nationally representative data on the association of household cooking place and respiratory infections. Besides, evidence on the variability in the infection based on the data collected at different times is limited. Therefore, this study is intended to assess the association of food cooking place with acute respiratory infections and the variability in households and surveys.

Methods

The current analysis is based on the Ethiopian Demographic and Health Survey data collected in 2005, 2011, and 2016 and obtained via online registration. The association of food cooking place with acute respiratory infection was assessed using multilevel modeling after categorizing all factors into child level and survey level, controlling them in a full model. The analyses accounted for a complex survey design using a Stata command “svy.”

Result

A total of 30,895 under-five children were included in this study, of which 3677 (11.9%) children had an acute respiratory infection, with 12.7% in 2005, 11.9% in 2011, and 11.1% in 2016. The risk of having an infection in under-five children in households that cooked food outdoors was 44% lower (AOR = 0.56, 95% CI = 0.40, 0.75) compared to those households that cooked the food inside the house. There was a statistically significant difference among the children among surveys to have an acute respiratory infection.

Conclusion

The risk of having children with acute respiratory infection is lower in the households of cooking food outdoor compared to indoor. The infection difference in different surveys suggests progress in the practices in either food cooking places or the fuel types used that minimize food cooking places location or the fuel types used that minimizes the risk. But, the infection is still high; therefore, measures promoting indoor cooking in a well-ventilated environment with alternative energy sources should take place.

Evaluating the Effect of Ambient Concentrations, Route Choices, and Environmental (in)Justice on Students' Dose of Ambient NO2 While Walking to School at Population Scales

The commuting microenvironment accounts for a large part of students' diurnal exposure to air pollution, especially in cities in developed countries where air pollution is caused predominantly by vehicle traffic. Accurate quantification of students' exposure and pollution dose during their commute from home to school requires their home addresses and details of the schools they attend. Such details are usually inaccessible or difficult to obtain at population scales due to privacy issues. Therefore, estimates of students' exposure to, and dose of, air pollution at population scales have to rely on simulated origins and destinations, which may bias the results. This contribution overcomes this limitation by quantifying students' terrain-based dosage of ambient nitrogen dioxide (NO₂) during their commute from home to school while walking along (a) the shortest-distance routes and (b) an alternative lowest-dose route. This is determined at population scales for students in Auckland, New Zealand using a rich dataset of observed home addresses and schools attended for 14,091 walking students. This study also determines the bias introduced when using simulated addresses (as opposed to observed data) to calculate the same result. Finally, we examine exposure inequalities among students of different socioeconomic backgrounds at school, at home, and during walking commutes. Results show that only 17.48% of students in the whole of Auckland can find alternative lowest-dose routes. The portion is higher (26%) in central Auckland because of its better road network connectivity. The trade-off analysis identifies that for only about 30% of students, a 1% increase in route length is associated with a >1% reduction in dosage if using the alternative lowest-dose route. Greater benefits were observed in suburban Auckland (a less-polluted area) than in central Auckland, which highlights the importance of taking an alternative lowest-dose route, especially for students whose shortest-distance routes overlap with or run parallel to an arterial road. The use of simulated addresses resulted in underestimates of both the length and reduced dosage of the alternative routes by up to a quarter in comparison with the results derived from the observed data. Limited evidence of exposure inequality based on commuter exposure was found, but patterns in the central city were opposite to those in the suburbs.

Assessing schoolchildren's exposure to air pollution during the daily commute - A systematic review

Air pollution is mostly caused by emissions from human activities, and exposure to air pollution is linked with numerous adverse human health outcomes. Recent studies have identified that although people only spend a small proportion of time on their daily commutes, the commuter microenvironment is a significant contributor to their total daily air pollution exposure. Schoolchildren are a particularly vulnerable cohort of the population, and their exposure to air pollution at home or school has been documented in a number of case studies. A few studies have identified that schoolchildren's exposure during commutes is linked with adverse cognitive outcomes and severe wheeze in asthmatic children. However, the determinants of total exposure, such as route choice and commute mode, and their subsequent health impacts on schoolchildren are still not well-understood. The aim of this paper is to review and synthesize recent studies on assessing schoolchildren's exposure to various air pollutants during the daily commute. Through reviewing 31 relevant studies published between 2004 and 2020, we tried to identify consistent patterns, trends, and underlying causal factors in the results. These studies were carried out across 10 commute modes and 12 different air pollutants. Air pollution in cities is highly heterogeneous in time and space, and commuting schoolchildren move through the urban area in complex ways. Measurements from fixed monitoring stations (FMSs), personal monitoring, and air quality modeling are the three most common approaches to determining exposure to ambient air pollutant concentrations. The time-activity diary (TAD), GPS tracker, online route collection app, and GIS-based route simulation are four widely used methods to determine schoolchildren's daily commuting routes. We found that route choices exerted a determining impact on schoolchildren's exposure. It is challenging to rank commute modes in order of exposure, as each scenario has numerous uncontrollable determinants, and there are notable research gaps. We suggest that future studies should concentrate on examining exposure patterns of schoolchildren in developing countries, exposure in the subway and trains, investigating the reliability of current simulation methods, exploring the environmental justice issue, and identifying the health impacts during commuting. It is recommended that three promising tools of smartphones, data fusion, and GIS should be widely used to overcome the challenges encountered in scaling up commuter exposure studies to population scales.

Climate Change and Childhood Respiratory Health: A Call to Action for Paediatricians

Climate change (CC) is one of the main contributors to health emergencies worldwide. CC appears to be closely interrelated with air pollution, as some pollutants like carbon dioxide (CO2), nitrogen oxides (NOx) and black carbon are naturally occurring greenhouse gases. Air pollution may enhance the allergenicity of some plants and, also, has an adverse effect on respiratory health. Children are a uniquely vulnerable group that suffers disproportionately from CC burden. The increasing global warming related to CC has a big impact on plants' lifecycles, with earlier and longer pollen seasons, as well as higher pollen production, putting children affected by asthma and allergic rhinitis at risk for exacerbations. Extreme weather events may play a role too, not only in the exacerbations of allergic respiratory diseases but, also, in favouring respiratory infections. Even though paediatricians are already seeing the impacts of CC on their patients, their knowledge about CC-related health outcomes with specific regards to children's respiratory health is incomplete. This advocates for paediatricians' increased awareness and a better understanding of the CC impact on children's respiratory health. Having a special responsibility for children, paediatricians should actively be involved in policies aimed to protect the next generation from CC-related adverse health effects. Hence, there is an urgent need for them to take action and successfully educate families about CC issues. This paper aims at reviewing the evidence of CC-related environmental factors such as temperature, humidity, rainfall and extreme events on respiratory allergic diseases and respiratory infections in children and proposing specific actionable items for paediatricians to deal with CC-related health issues in their clinical practice.

The relationship between environmental awareness, environmental behaviors, and carbon footprint in Turkish households

Having knowledge about household environmental behaviors is important for planning and conducting efforts to reduce carbon footprint. In this study, the relationship between environmental awareness, purchasing, household practices, and carbon footprint was investigated, and the impact of demographics on these variables was determined. The analysis shows that sensitivity dimension of environmental awareness is related to few environmental behavior variables (purchasing and efficiency) whereas willingness dimension was related to all variables (except gas). While improvements in demographic factors (income, education, and female employment status) positively affect environmental sensitivity, they increase carbon footprint from automobile. Only increase in income has an effect on willingness. It is determined that income positively affects environmental purchasing. Furthermore, it is revealed that environmental household practices did not differ in terms of demographic characteristics, except the effect of education on pollution.

Co-Benefits to Children's Health of the U.S. Regional Greenhouse Gas Initiative

BACKGROUND

While various policies have been implemented globally to mitigate climate change and reduce exposure to toxic air pollutants, policy assessments have considered few if any of the benefits to children.

OBJECTIVE

To comprehensively assess the co-benefits of climate change mitigation to children, we expanded the suite of adverse health outcomes in the U.S. Environmental Protection Agency's Benefits Mapping and Analysis Program (BenMAP) to include additional outcomes associated with prenatal and childhood exposure to ambient fine particulate matter (PM2.5). We applied this newly expanded program to an assessment of the U.S. Regional Greenhouse Gas Initiative (RGGI), the United States' first regional market-based regulatory program designed to reduce greenhouse gas emissions from the electric power sector within the Northeast.

METHODS

We used calculated changes in ambient PM2.5 concentrations for the period 2009-2014, with newly incorporated concentration-response (C-R) functions to quantify changes in the incidence of preterm birth (PTB), term low birth weight (TLBW), autism spectrum disorder (ASD), and asthma. These outcomes are causally or likely to be causally related to PM2.5 exposure. Cost per case estimates were incorporated to monetize those changes in incidence.

RESULTS

The estimated avoided cases of adverse child health outcomes included 537 asthma cases, 112 preterm births, 98 cases of ASD, and 56 cases of TLBW, with an associated avoided cost estimate ranging from $191 to $350 million. In a previous analysis of health benefits of RGGI, the only benefits accruing to children were limited to prevented cases of infant mortality and respiratory illnesses, with a monetized impact of $8.1 million-only 2-4% of the new results attributable to RGGI.

CONCLUSION

The results of this innovative analysis indicate that RGGI has provided substantial child health benefits beyond those initially considered. Moreover, those health benefits had significant estimated economic value. https://doi.org/10.1289/EHP6706.

Climate Change and Risk of Completed Suicide

Climate change is increasingly recognized as having multiple adverse mental health effects, many of which are just beginning to be understood. The elevated rates of suicides observed in some communities affected by climate change and rising rates of suicide in the United States as climate change intensifies have suggested the two may be associated. We searched PubMed and PsycInfo using the terms climate change and suicide, and provide here a review of the current literature on climate change and suicide that explores possible associations and methodological issues and challenges in this research.

Short-term exposure to air pollution (PM2.5) induces hypothalamic inflammation, and long-term leads to leptin resistance and obesity via Tlr4/Ikbke in mice

A previous study demonstrated that a high-fat diet (HFD), administered for one-three-days, induces hypothalamic inflammation before obesity’s established, and the long term affects leptin signaling/action due to inflammation. We investigate whether exposure to particulate matter of a diameter of ≤2.5 μm (PM_2.5) in mice fed with a chow diet leads to similar metabolic effects caused by high-fat feeding. Compared to the filtered air group (FA), one-day-exposure-PM_2.5 did not affect adiposity. However, five-days-exposure-PM_2.5 increased hypothalamic microglia density, toll-like-receptor-4 (Tlr4), and the inhibitor-NF-kappa-B-kinase-epsilon (Ikbke) expression. Concurrently, fat mass, food intake (FI), and ucp1 expression in brown adipose tissue were also increased. Besides, decreased hypothalamic STAT3-phosphorylation and Pomc expression were found after twelve-weeks-exposure-PM_2.5. These were accompanied by increased FI and lower energy expenditure (EE), leading to obesity, along with increased leptin and insulin levels and HOMA. Mechanistically, the deletion of Tlr4 or knockdown of the Ikbke gene in the hypothalamus was sufficient to reverse the metabolic outcomes of twelve-weeks-exposure-PM_2.5. These data demonstrated that short-term exposure-PM_2.5 increases hypothalamic inflammation, similar to a HFD. Long-term exposure-PM_2.5 is even worse, leading to leptin resistance, hyperphagia, and decreased EE. These effects are most likely due to chronic hypothalamic inflammation, which is regulated by Tlr4 and Ikbke signaling.

Controlling and preventing climate-sensitive noncommunicable diseases in urban sub-Saharan Africa

Research continues to highlight the link between climate change and health outcomes. There is, however, limited evidence in research, policies and in the Sustainable Development Goals (SDGs) about the impact of environmental factors on noncommunicable diseases (NCDs) for people living in urban areas of sub-Saharan Africa (SSA). Important is that 80% of NCDs are taking place in low- and middle-income countries (LMICs) and linked to a third of the deaths in SSA. The question is, what would these statistics look like if environmental risk factors (e.g., pollution, chemicals) for NCDs, linked to climate change, were prevented and controlled. This article presents a framework for understanding climatic pathways' impacts on climate-sensitive NCDs and achieving the SDGs. It further explains how current global mitigation interventions in high income urban settings, with implied health co-benefits for NCD reduction (i.e., promoting use of less polluting vehicles, bicycles, walking, public transport, green spaces), experience major implementation challenges in SSA cities (i.e., too costly, lack of availability, poor road conditions, gender and cultural norms, security problems). Recommendations are made for applying this framework to control climate change impacts on NCDs and achieving the SDGs in SSA cities. These include, support for more research on the climate - NCD nexus, ensuring health professional training includes sustainable health education, and including a focus on climate change and health in primary and secondary school curricula. Further recommendations for addressing climate-sensitive NCDs and urban environmental health towards achieving and sustaining the SDGs, are linked to promoting climate-sensitive and health policies and governance, as well as controlling the influence of advertising. Lastly, improving communication of research findings for policy makers and the public in a manner for informed policy making, and how to comprehend this information to promote the reduction and prevention of NCDs in urban SSA, is key.

Lagging and Flagging: Air Pollution, Shale Gas Exploration and the Interaction of Policy, Science, Ethics and Environmental Justice in England

The science on the effects of global climate change and air pollution on morbidity and mortality is clear and debate now centres around the scale and precise contributions of particular pollutants. Sufficient data existed in recent decades to support the adoption of precautionary public health policies relating to fossil fuels including shale exploration. Yet air quality and related public health impacts linked to ethical and environmental justice elements are often marginalized or missing in planning and associated decision making. Industry and government policies and practices, laws and planning regulations lagged well behind the science in the United Kingdom. This paper explores the reasons for this and what shaped some of those policies. Why did shale gas policies in England fail to fully address public health priorities and neglect ethical and environmental justice concerns. To answer this question, an interdisciplinary analysis is needed informed by a theoretical framework of how air pollution and climate change are largely discounted in the complex realpolitik of policy and regulation for shale gas development in England. Sources, including official government, regulatory and planning documents, as well as industry and scientific publications are examined and benchmarked against the science and ethical and environmental justice criteria. Further, our typology illustrates how the process works drawing on an analysis of official policy documents and statements on planning and regulatory oversight of shale exploration in England, and material from industry and their consultants relating to proposed shale oil and gas development. Currently the oil, gas and chemical industries in England continue to dominate and influence energy and feedstock-related policy making to the detriment of ethical and environmental justice decision making with significant consequences for public health.

Reviewing Usage, Potentials, and Limitations of Renewable Energy Sources

The world’s ever-increasing population, combined with economic and technological growth and a new, modern way of life, has led to high energy demand and consumption. Fossil fuels have been the main energy source for many years, but their use has many negative impacts on the environment. This has made the transition to renewable energy sources necessary in order to address climate change and meet the 1.5 °C goal. This paper is a review of the different types of renewables, their potentials and limitations, and their connection to climate change, economic growth, and human health. It also examines consumers’ willingness to pay for renewables in different countries, based on the existing literature. IEA (International Energy Agency) data are analyzed, concerning renewables’ current use, the evolution of their usage, and forecasts about their future usage. Finally, policies and strategies are recommended in order to address climate change and fully integrate renewables as a sustainable energy source.

Quantification of air pollution exposure to in-pram babies and mitigation strategies

Young children are particularly vulnerable to air pollution exposure during their early childhood development, yet research on exposure to in-pram babies in different types of single/double prams is limited. This work aims to mimick their exposure to multiple air pollutants - particulate matter ≤10 µm in aerodynamic diameter (PM₁₀), ≤2.5 µm (PM_2.5; fine particles), ≤1 µm (PM₁), ≤0.10 µm (measured as particle number concentration, PNC) - in three different types of prams (single pram facing the road; single pram facing parents; double pram facing the road). We also assessed the differences in exposure concentrations between typical adult and in-pram baby breathing height via simultaneous measurements besides assessing their physico-chemical properties (morphology and elemental composition). In addition, we analysed the impact of pram covers in mitigating in-pram exposure concentrations of selected pollutants. We carried out a total of 89 single runs, repeating on a 2.1 km long pre-defined route between an origin-destination pair (the University of Surrey to a local school) during the morning (08:00-10:00 h; local time) and afternoon (15:00-17:00 h) hours. These run simulated morning drop-off and afternoon pick-off times of school children. Overall, the experimental runs took about 66 h and covered the total length of 145 km. Substantial variability is observed in measured concentrations of different pollutants within each run (e.g., up to 290-times for PNC) and between different runs performed during different times of the day (e.g., ~62% variability in average PNC; ~7% for PM₁ and 8% for PM_2.5 during morning versus afternoon). The average in-pram concentration of fine particles was always higher by up to 44% compared with adult breathing height during both morning and afternoon runs. The comparison of exposure concentrations at two different sitting heights of double pram showed that PNC concentrations were higher by about 72% at the bottom seat compared to the top seat. Scanning electron microscope (SEM) analysis of PM_2.5-10 revealed traces of brake wear, tyre wear and re-suspended dust minerals with the predominance of brake and tyre wear emissions at baby height compared with a relatively larger share of earth crust elements at adult height. For mitigation measures, pram covers reduced concentrations of small-sized particles by as much as 39% (fine particles) and 43% (coarse particles). Our results reinforce the need for mitigating exposures to in-pram babies, especially at urban pollution hotspots such as busy congested roads, bus stops, and traffic intersections.

Youth Engaged Participatory Air Monitoring: A 'Day in the Life' in Urban Environmental Justice Communities

Air pollution in Southern California does not impact all communities equally; communities of color are disproportionately burdened by poor air quality and more likely to live near industrial facilities and freeways. Government regulatory monitors do not have the spatial resolution to provide air quality information at the neighborhood or personal scale. We describe the A Day in the Life program, an approach to participatory air monitoring that engages youth in collecting data that they can then analyze and use to take action. Academics partnered with Los Angeles-based youth environmental justice organizations to combine personal air monitoring, participatory science, and digital storytelling to build capacity to address local air quality issues. Eighteen youth participants from four different neighborhoods wore portable personal PM2.5 (fine particles <2.5 µm in diameter) monitors for a day in each of their respective communities, documenting and mapping their exposure to PM2.5 during their daily routine. Air monitoring was coupled with photography and videos to document what they experienced over the course of their day. The PM2.5 exposure during the day for participants averaged 10.7 µg/m3, although the range stretched from <1 to 180 µg/m3. One-third of all measurements were taken <300 m from a freeway. Overall, we demonstrate a method to increase local youth-centered understanding of personal exposures, pollution sources, and vulnerability to air quality.

How Energy Consumption and Pollutant Emissions Affect the Disparity of Public Health in Countries with High Fossil Energy Consumption

Public health issues are a global focus, but recent research on the links between fossil energy consumption, pollutant emissions, and public health in different regions have presented inconsistent conclusions. In order to quantify the effect of fossil energy use and pollutant emissions on public health from the global perspective, this paper investigates 33 countries with high GDP and fossil energy consumption from 1995 to 2015 using a fixed effect model. Further, this paper utilizes heterogeneity analysis to characterize the disparity of countries with different features. Empirical results indicate that total fossil energy consumption is beneficial to the life expectancy of the population (LEP), but pollutant emissions (PM10 concentration and greenhouse gas scale) have a negative effect on LEP. Moreover, the heterogeneity test indicates that pollutant emissions lowers LEP in net energy importers more than in net energy exporters, and the effect of such emissions in low- and middle-income countries on public health is more harmful than that in high-income countries. These findings suggest that it is a greater priority for governments to strengthen the control of pollutant emissions through enhancing the efficiency of energy consumption, rather than by reducing its scale of use in low- and middle-income, and net energy importing countries. Additionally, governments also need to focus on the volatility of pollutant emissions in high-income countries with necessary control measures.

Unit-Based Emissions Inventory for Electric Power Systems in Kuwait: Current Status and Future Predictions

Obtaining accurate estimates of emissions from electric power systems is essential for predicting air quality and evaluating the effectiveness of any future control technologies. This paper aimed to develop unit-based emissions inventories for electric power systems in Kuwait using different parameters, including fuel specifications and consumption, combustion technology and its efficiency, unit capacity, and boiler type. The study also estimated the future emissions of NOx, SO2, CO, CO2, and PM10 up to the year 2030 using a multivariate regression model in addition to predicting future energy demand. The results showed that annual (2010–2015) emissions of all air pollutants, excluding SO2 and PM10, increased over the study period. CO had the greatest increase of 41.9%, whereas SO2 levels decreased the most by 13% over the 2010 levels, due to the replacement of heavy fuel oil. Energy consumption in 2015 stood at approximately 86 PJ, with natural gas, gas oil, crude oil, and heavy fuel oil making up 51.2%, 10.7%, 3.1%, and 35%, respectively. Energy demand was projected to grow at an annualized rate of 2.8% by 2030 compared to 2015 levels. The required installed capacity to meet this demand was estimated to be approximately 21.8 GW (a 34% increase in capacity compared to 2015 levels). The projected emission rates showed that, of the five air pollutants, SO2 and PM10 are expected to decrease by 2030 by 34% and 11%, respectively. However, peak monthly emissions of SO2 would still only be 14% lower compared to the 2015 monthly average. In contrast, emission levels are projected to increase by 34.3%, 54.8%, and 71.8% for CO2, NOx, and CO, respectively, by 2030 compared to 2015 levels. Accordingly, a more ambitious target of renewables penetration needs to be adopted to reduce emission levels going forward.

Associations between Indoor Air Pollution and Acute Respiratory Infections among Under-Five Children in Afghanistan: Do SES and Sex Matter?

Background: Low-income families often depend on fuels such as wood, coal, and animal dung for cooking. Such solid fuels are highly polluting and are a primary source of indoor air pollutants (IAP). We examined the association between solid fuel use (SFU) and acute respiratory infection (ARI) among under-five children in Afghanistan and the extent to which this association varies by socioeconomic status (SES) and gender. Materials and Methods: This is a cross-sectional study based on de-identified data from Afghanistan’s first standard Demographic and Health Survey (DHS) conducted in 2015. The sample consists of ever-married mothers with under-five children in the household (n = 27,565). We used mixed-effect Poisson regression models with robust error variance accounting for clustering to examine the associations between SFU and ARI among under-five children after adjusting for potential confounders. We also investigated potential effect modification by SES and sex. Additional analyses were conducted using an augmented measure of the exposure to IAP accounting for both SFU and the location of cooking/kitchen (High Exposure, Moderate, and No Exposure). Results: Around 70.2% of households reported SFU, whereas the prevalence of ARI was 17.6%. The prevalence of ARI was higher in children living in households with SFU compared to children living in households with no SFU (adjusted prevalence ratio (aPR) = 1.10; 95% CI: (0.98, 1.23)). We did not observe any effect modification by SES or child sex. When using the augmented measure of exposure incorporating the kitchen’s location, children highly exposed to IAP had a higher prevalence of ARI compared to unexposed children (aPR = 1.17; 95% CI: (1.03, 1.32)). SES modified this association with the strongest associations observed among children from the middle wealth quintile. Conclusion: The findings have significant policy implications and suggest that ARI risk in children may be reduced by ensuring there are clean cookstoves as well as clean fuels and acting on the socio-environmental pathways.

Benzo[a]pyrene is associated with dysregulated myelo-lymphoid hematopoiesis in asthmatic children

BACKGROUND

The extent to which ambient benzo[a]pyrene (B[a]P) contributes to mechanistically distinct de novo asthma remains unknown.

OBJECTIVES

To identify molecular signatures and regulatory networks underlying childhood exposure to ambient B[a]P and asthma, using robust and unbiased systems biology approaches.

METHODS

Clinically confirmed asthmatic (n = 191) vs. control (n = 194) children (aged, 7-15) were enrolled from a polluted urban center and semi-rural region in Czech Republic. Contemporaneous B[a]P concentration, gene expressions, DNA methylation data were analyzed against asthma diagnosis, as well as a modified prognostic index of asthma, using integrative multiscale co-expression network analysis. Sample-wise cell type compositions were inferred by a machine learning approach (i.e. CIBERSORT) with reference gene expressions of purified 38 distinct hematopoietic cell states from umbilical cord (i.e. stem cell/progenitors) or peripheral blood (i.e. lymphocytes).

RESULTS

The median outdoor B[a]P was increased near the homes of the urban children with 'moderate' or 'severe' prognostic markers of asthma, but not in the urban controls. An elevated B[a]P induced epigenetic suppression of NF-κB inflammation, decreased Natural Killer T (NKT) cells and activated anti-inflammatory IL10-secreting CD8+ T effective memory cells. B[a]P was positively correlated with an increased expression of a heme biosynthesis gene, ALAS2, which in turn, appears to promote concurrent increase of neutrophilic metamyelocyte and mature CD71^low erythroid cells. Furthermore, erythroid-specific master transcription regulator gene (GATA1), glutathione transferase genes (GSTM1 and GSTM3) and Eosinophil marker (IL5RA) were simultaneously activated in the urban asthma cases.

CONCLUSIONS

B[a]P might contribute to concurrent suppression of pro-inflammatory (e.g. NF-κB mediated NKT cells), and activation of anti-inflammatory pathways (e.g. IL10-secreting CD8+ T cells) in the urban asthmatic children. In addition, B[a]P appears to elevate heme biosynthesis, which in turn, promotes neutrophilic metamyelocyte expansion and reduction of CD71⁺ erythroids.

Understanding xylose isomerase from Burkholderia cenocepacia: insights into structure and functionality for ethanol production

The inability of the yeast Saccharomyces cerevisiae to produce ethanol from xylose has hampered the biofuel production from lignocellulosic biomass. However, prior studies reveal that functional expression of xylose isomerase (XI) from Burkholderia cenocepacia (XylA_Bc) in S. cerevisiae has remarkably improved xylose consumption and ethanol productivity. Yet, little is known about kinetic and structural properties of this enzyme. Hereby, a purified recombinant XylA was assayed in vitro, showing optimal enzyme activity at 37 °C and pH 7.2. The K_m of XylA for d-xylose was at least threefold lower than the K_m results for any XI published to date (e.g. XylA from Piromyces sp.). In addition, oligomerization behavior as a tetramer was observed for XylA in solution. Functional and structural comparative analyses amongst three microbial XIs were further performed as theoretical models, showing that xylose orientation at the active site was highly conserved among the XIs. Mg²⁺ ions anchor the sugar and guide its pyranoside oxygen towards a histidine residue present at the active site, allowing an acid–base reaction, linearizing xylose. Electrostatic surface analyses showed that small variations in the net charge distribution and dipole moment could directly affect the way the substrate interacts with the protein, thus altering its kinetic properties. Accordingly, in silico modeling suggested the tetramer may be the major functional form. These analyses and the resulting model promote a better understanding of this protein family and pave the way to further protein engineering and application of XylA in the ethanol industry.

Towards a fuller assessment of benefits to children's health of reducing air pollution and mitigating climate change due to fossil fuel combustion

BACKGROUND

Fossil fuel combustion by-products, including particulate matter (PM_2.5), polycyclic aromatic hydrocarbons (PAH), nitrogen dioxide (NO₂) and carbon dioxide (CO₂), are a significant threat to children's health and equality. Various policies to reduce emissions have been implemented to reduce air pollution and mitigate climate change, with sizeable estimated health and economic benefits. However, only a few adverse outcomes in children have been considered, resulting in an undercounting of the benefits to this vulnerable population.

OBJECTIVES

Our goal was to expand the suite of child health outcomes addressed by programs to assess health and economic benefits, such as the Environmental Protection Agency (EPA) Benefits Mapping and Analysis Program (BenMAP), by identifying concentration-response (C-R) functions for six outcomes related to PM_2.5, NO₂, PAH, and/or PM₁₀: preterm birth (PTB), low birthweight (LBW), autism, attention deficit hyperactivity disorder, IQ reduction, and the development of childhood asthma.

METHODS

We conducted a systematic review of the literature published between January 1, 2000 and April 30, 2018 to identify relevant peer-reviewed case-control and cohort studies and meta-analyses. In some cases meta-analyses were available that provided reliable C-R functions and we assessed their consistency with subsequent studies. Otherwise, we reviewed all eligible studies published between our search dates.

RESULTS

For each pollutant and health outcome, we present the characteristics of each selected study. We distinguish between C-R functions for endpoints having a causal or likely relationship (PTB, LBW, autism, asthma development) with the pollutants for incorporation into primary analyses and endpoints having a suggestive causal relationship with the pollutants (IQ reduction, ADHD) for secondary analyses.

CONCLUSION

We have identified C-R functions for a number of adverse health outcomes in children associated with air pollutants largely from fossil fuel combustion. Their incorporation into expanded assessments of health benefits of clean air and climate mitigation policies will provide an important incentive for preventive action.

Preterm birth and economic benefits of reduced maternal exposure to fine particulate matter

Preterm birth (PTB) is a predictor of infant mortality and later-life morbidity. Despite recent declines, PTB rates remain high in the United States. Growing research suggests a possible relationship between a mother's exposure to common air pollutants, including fine particulate matter (PM_2.5), and PTB of her baby. Many policy actions to reduce exposure to common air pollutants require benefit-cost analysis (BCA), and it's possible that PTB will need to be included in BCA in the future. However, an estimate of the willingness to pay (WTP) to avoid PTB risk is not available, and a comprehensive alternative valuation of the health benefits of reducing pollutant-related PTB currently does not exist. This paper demonstrates an approach to assess potential economic benefits of reducing PTB resulting from environmental exposures when an estimate of WTP to avoid PTB risk is unavailable. We utilized a recent meta-analysis, county-level air quality data and county-level PTB prevalence data to estimate the potential health and economic benefits of a reduction in air pollution-related PTB, with PM_2.5 as our case study pollutant. Using this method, a simulated nationwide 10% decrease from 2008 PM_2.5 levels resulted in an estimated reduction of 5016 PTBs and benefits of at least $339 million, potentially reaching over one billion dollars when considering later-life effects of PTB.

The Impact of Future Fuel Consumption on Regional Air Quality in Southeast Asia

Aerosols emitted from fossil fuel burning can cause air quality and human health issues. In this sensitivity study, we examine the impact of fossil fuel aerosols on air quality in Southeast Asia under five different hypothetical fuel consumption scenarios. These scenarios reflect air pollutant outcomes of implementations of certain idealized policies in the power generation, industry, and residential sectors. Analyses based on comparison among the modeling results from these scenarios reveal the sectors that should be targeted by air pollution mitigation policy. The results reveal that in Southeast Asia, sulfate could be decreased by 25% if coal were to be replaced by natural gas in the power generation and industry sectors. Black carbon concentration would reduce 42% overall if biofuel were replaced by natural gas in the residential sector. Shipping emissions are especially critical for the urban air quality in Singapore: fine particular matters (PM_2.5) could be dramatically cut by 69% in Singapore by merely eliminating shipping emissions.

Pollution and children's health

FINDINGS

The Lancet Commission on Pollution and Health found that pollution - air, water, soil, and chemical pollution - was responsible in 2016 for 940,000 deaths in children worldwide, two-thirds of them in children under the age of 5. Pollution is inequitably distributed, and the overwhelming majority of pollution-related deaths in children occurred in low- and middle-income countries (LMICs). Most were due to respiratory and gastrointestinal diseases caused by polluted air and water. Pollution is linked also to multiple non-communicable diseases (NCDs) in children including low birth weight, asthma, cancer and neurodevelopmental disorders, and these diseases are on the rise. The full impact of pollution, especially chemical pollution on the global burden of pediatric disease is not yet known, but almost certainly is undercounted because patterns of chemical exposure are not well charted and the potential toxicity of many chemical pollutants has not been characterized. The list of pediatric NCDs attributed to pollution will likely expand as the health effects of newer chemical pollutants are better defined and additional associations between pollution and disease are discovered.

CONCLUSION

Pollution prevention presents a major, largely unexploited opportunity to improve children's health and prevent NCDs, especially in LMICs. Failure to incorporate pollution prevention into NCD control programs is a major missed opportunity for disease prevention.

Bio-Integrated Wearable Systems: A Comprehensive Review

Bio-integrated wearable systems can measure a broad range of biophysical, biochemical, and environmental signals to provide critical insights into overall health status and to quantify human performance. Recent advances in material science, chemical analysis techniques, device designs, and assembly methods form the foundations for a uniquely differentiated type of wearable technology, characterized by noninvasive, intimate integration with the soft, curved, time-dynamic surfaces of the body. This review summarizes the latest advances in this emerging field of "bio-integrated" technologies in a comprehensive manner that connects fundamental developments in chemistry, material science, and engineering with sensing technologies that have the potential for widespread deployment and societal benefit in human health care. An introduction to the chemistries and materials for the active components of these systems contextualizes essential design considerations for sensors and associated platforms that appear in following sections. The subsequent content highlights the most advanced biosensors, classified according to their ability to capture biophysical, biochemical, and environmental information. Additional sections feature schemes for electrically powering these sensors and strategies for achieving fully integrated, wireless systems. The review concludes with an overview of key remaining challenges and a summary of opportunities where advances in materials chemistry will be critically important for continued progress.

Variation of fatty acid desaturation in response to different nitrate levels in Auxenochlorella pyrenoidosa

Microalgae are promising feedstocks for biodiesel, where the high proportion of monounsaturated fatty acid such as oleic acid (C18:1) is preferred. To regulate fatty acid desaturation in microalgae, the relationship among nitrate concentration, fatty acid composition and the expression levels of desaturase genes was explored. Dynamic variations of fatty acid profiles suggested nitrate could induce desaturation of C18 fatty acids. The content of C18:1 in Auxenochlorella pyrenoidosa was 30.88% at 0 g l^-1 nitrate concentration compared with 0.48% at 1.5 g l^-1. The expressions of relative delta-9, 12 and 15 fatty acid desaturase genes (Δ9, Δ12 and Δ15FADs) were further investigated. The 330% upregulated expression of Δ9FAD in logarithmic phase at 0 g l^-1 resulted in C18:1 accumulation. Moreover, nitrate replenishment caused a sharp reduction of C18:1 from 34.79% to 0.22% and downregulation of Δ9FAD expression to 1% of the nitrate absence level, indicating the pivotal role of Δ9FAD in C18:1 accumulation. Finally, overexpression of Δ9FAD in Escherichia coli and Saccharomyces cerevisiae resulted in an increase of C18:1, confirming its ability of desaturating C18:0. The results could provide a new approach and scientific guidance for the improvement of biodiesel quality and industrialization of high-valued chemicals by means of metabolic engineering.

A review of factors surrounding the air pollution exposure to in-pram babies and mitigation strategies

Air pollution exposure to in-pram babies poses a serious threat to their early childhood development, necessitating a need for effective mitigation measures. We reviewed the scientific and grey literature on in-pram babies and their personal exposure to traffic generated air pollutants such as particulate matter ≤10 μm (PM₁₀), ≤2.5 μm (PM_2.5), ≤0.10 μm (ultrafine particles) in size, black carbon and nitrogen oxides and potential mitigation pathways. In-pram babies can be exposed up to ~60% higher average concentrations depending on the pollutant types compared with adults. The air within the first few meters above the road level is usually most polluted. Therefore, we classified various pram types based on criteria such as height, width and the seating capacity (single versus twin) and assessed the breathing heights of sitting babies in various pram types available in the market. This classification revealed the pram widths between 0.56 and 0.82 m and top handle heights up to ~1.25 m as opposed to breathing height between 0.55 and 0.85 m, suggesting that the concentration within the first meter above the road level is critical for exposure to in-pram babies. The assessment of flow features around the prams suggests that meteorological conditions (e.g., wind speed and direction) and traffic-produced turbulence affect the pollution dispersion around them. A survey of the physicochemical properties of particles from roadside environment demonstrated the dominance of toxic metals that have been shown to damage their frontal lobe as well as cognition and brain development when inhaled by in-pram babies. We then assessed a wide range of active and passive exposure mitigation strategies, including a passive control at the receptor such as the enhanced filtration around the breathing zone and protection of prams via covers. Technological solutions such as creating a clean air zone around the breathing area can provide instant solutions. However, a holistic approach involving a mix of innovative technological solutions, community empowerment and exposure-centric policies are needed to help limit personal exposure of in-pram babies.

Creating individual level air pollution exposures in an anonymised data safe haven: a platform for evaluating impact on educational attainment

Introduction

There is a lack of evidence on the adverse effects of air pollution on cognition for people with air quality-related health conditions. We propose that educational attainment, as a proxy for cognition, may increase with improved air quality. This study will explore whether asthma and seasonal allergic rhinitis, when exacerbated by acute exposure to air pollution, is associated with educational attainment.

Objective

To describe the preparation of individual and household-level linked environmental and health data for analysis within an anonymised safe haven. Also to introduce our statistical analysis plan for our study: COgnition, Respiratory Tract illness and Effects of eXposure (CORTEX).

Methods

We imported daily air pollution and aeroallergen data, and individual level education data into the SAIL databank, an anonymised safe haven for person-based records. We linked individual-level education, socioeconomic and health data to air quality data for home and school locations, creating tailored exposures for individuals across a city. We developed daily exposure data for all pupils in repeated cross sectional exam cohorts (2009-2015).

Conclusion

We have used the SAIL databank, an innovative, data safe haven to create individual-level exposures to air pollution and pollen for multiple daily home and school locations. The analysis platform will allow us to evaluate retrospectively the impact of air quality on attainment for multiple cross-sectional cohorts of pupils. Our methods will allow us to distinguish between the pollution impacts on educational attainment for pupils with and without respiratory health conditions. The results from this study will further our understanding of the effects of air quality and respiratory-related health conditions on cognition.

Highlights

Projecting Age-Stratified Risk of Exposure to Inland Flooding and Wildfire Smoke in the United States under Two Climate Scenarios

BACKGROUND

The public health community readily recognizes flooding and wildfires as climate-related health hazards, but few studies quantify changes in risk of exposure, particularly for vulnerable children and older adults.

OBJECTIVES

This study quantifies future populations potentially exposed to inland flooding and wildfire smoke under two climate scenarios, highlighting the populations in particularly vulnerable age groups (≤4 y old and ≥65 y old).

METHODS

Spatially explicit projections of inland flooding and wildfire under two representative concentration pathways (RCP8.5 and RCP4.5) are integrated with static (2010) and dynamic (2050 and 2090) age-stratified projections of future contiguous U.S. populations at the county level.

RESULTS

In both 2050 and 2090, an additional one-third of the population will live in areas affected by larger and more frequent inland flooding under RCP8.5 than under RCP4.5. Approximately 15 million children and 25 million older adults could avoid this increased risk of flood exposure each year by 2090 under a moderate mitigation scenario (RCP4.5 compared with RCP8.5). We also find reduced exposure to wildfire smoke under the moderate mitigation scenario. Nearly 1 million young children and 1.7 million older adults would avoid exposure to wildfire smoke each year under RCP4.5 than under RCP8.5 by the end of the century.

CONCLUSIONS

By integrating climate-driven hazard and population projections, newly created county-level exposure maps identify locations of potential significant future public health risk. These potential exposure results can help inform actions to prevent and prepare for associated future adverse health outcomes, particularly for vulnerable children and older adults. https://doi.org/10.1289/EHP2594.

A 'burning opportunity' for human rights: using human rights as a catalyst for policies to mitigate the health risk of household air pollution

With over 3 billion people dependent on traditional cooking and heating technologies, efforts to address the health burden of exposure to household air pollution (HAP), as well as other sociodemographic impacts associated with energy poverty, are central to sustainable development objectives. Yet despite overwhelming scientific consensus on the health burden of HAP exposure, particularly harms to impoverished women and children in developing countries, advocates currently lack a human rights framework to mitigate HAP exposure through improved access to cleaner household energy systems. This article examines the role of human rights in framing state obligations to mitigate HAP exposure, supporting environmental health for the most vulnerable through intersectional obligations across the human right to health, the collective right to development, and women's and children's rights. Drawing from human rights advocacy employed in confronting the public health harms of tobacco, we argue that rights-based civil society advocacy can structure the multi-sectoral policies necessary to address the impacts of HAP exposure and energy poverty, facilitating accountability for human rights implementation through international treaty bodies, national judicial challenges and local political advocacy. We conclude that there is a pressing need to build civil society capacity for a rights-based approach to cleaner household energy policy as a means to alleviate the environmental health effects of energy poverty.

Trace Metal Content of Coal Exacerbates Air-Pollution-Related Health Risks: The Case of Lignite Coal in Kosovo

More than 6600 coal-fired power plants serve an estimated five billion people globally and contribute 46% of annual CO₂ emissions. Gases and particulate matter from coal combustion are harmful to humans and often contain toxic trace metals. The decades-old Kosovo power stations, Europe's largest point source of air pollution, generate 98% of Kosovo's electricity and are due for replacement. Kosovo will rely on investment from external donors to replace these plants. Here, we examine non-CO₂ emissions and health impacts by using inductively coupled plasma mass spectrometry (ICP-MS) to analyze trace metal content in lignite coal from Obilic, Kosovo. We find significant trace metal content normalized per kWh of final electricity delivered (As (22.3 ± 1.7), Cr (44.1 ± 3.5), Hg (0.08 ± 0.010), and Ni (19.7 ± 1.7) mg/kWh_e). These metals pose health hazards that persist even with improved grid efficiency. We explore the air-pollution-related risk associated with several alternative energy development pathways. Our analysis estimates that Kosovo could avoid 2300 premature deaths by 2030 with investments in energy efficiency and solar PV backed up by natural gas. Energy policy decisions should account for all associated health risks, as should multilateral development banks before guaranteeing loans on new electricity projects.

Children's environmental chemical exposures in the USA, NHANES 2003-2012

Children are vulnerable to environmental chemical exposures, but little is known about the extent of multiple chemical exposures among children. We analyzed biomonitoring data from five cycles (2003-2012) of the National Health and Nutrition Examination Survey (NHANES) to describe multiple chemical exposures in US children, examine levels of chemical concentrations present over time, and examine differences in chemical exposures by selected demographic groups. We analyzed data for 36 chemical analytes across five chemical classes in a sample of 4299 children aged 6-18. Classes included metals, pesticides, phthalates, phenols, and polycyclic aromatic hydrocarbons. We calculated the number and percent of chemicals detected and tested for secular trends over time in chemical concentrations. We compared log concentrations among groups defined by age, sex, race/ethnicity, and poverty using multiple linear regression models and report adjusted geometric means. Among a smaller subgroup of 733 children with data across chemical classes, we calculated the linear correlations within and between classes and conducted a principal component analysis. The percentage of children with detectable concentrations of an individual chemical ranged from 26 to 100%; the average was 93%, and 29 of 36 were detected in more than 90% of children. Concentrations of most tested chemicals were either unchanged or declined from earlier to more recent years. Many differences in concentrations were present by age, sex, poverty, and race/ethnicity categories. Within and between class correlations were all significant and positive, and the principal component analysis suggested a one factor solution, indicating that children exposed to higher levels of one chemical were exposed to higher levels of other chemicals. In conclusion, children in the USA are exposed to multiple simultaneous chemicals at uneven risk across socioeconomic and demographic groups. Further efforts to understand the effects of multiple exposures on child health and development are warranted.

Latent class analysis to model multiple chemical exposures among children

BACKGROUND

Children are exposed to multiple potentially harmful chemicals simultaneously. Efforts to understand the patterns and consequences of these exposures have been hampered by statistical limitations in estimations of higher order interactions.

OBJECTIVES

The current study uses latent class analysis, a form of person-centered modeling to identify unobservable subgroups within populations and examine relationships between latent classes and measures of immune function.

METHODS

Data from the National Health and Nutrition Examination Survey 2011-2012 were analyzed. A sample of 721 children aged 6-19 years were included who provided data on 47 chemicals of interest representing six chemical classes. Groups were identified using latent class analysis controlling for race/ethnicity, age, sex and poverty status.

RESULTS

Two alternative approaches to identifying latent classes each resulted in similar three class solutions, including one group of children characterized by low co-exposures across chemicals, a group with moderate co-exposure levels, and a group characterized by high co-occurring levels of polycyclic aromatic hydrocarbons, volatile organic compounds, phenols and phthalates. Under one of the approaches, latent classes were significantly associated with immune function as measured by lymphocyte and neutrophil counts.

CONCLUSIONS

Latent class analysis offers a potential approach to measuring and understanding interactions among multiple co-occurring chemical stressors. However, additional work is needed to test the ability of latent classes to predict health variables.

Pollution from Fossil-Fuel Combustion is the Leading Environmental Threat to Global Pediatric Health and Equity: Solutions Exist

Fossil-fuel combustion by-products are the world's most significant threat to children's health and future and are major contributors to global inequality and environmental injustice. The emissions include a myriad of toxic air pollutants and carbon dioxide (CO₂), which is the most important human-produced climate-altering greenhouse gas. Synergies between air pollution and climate change can magnify the harm to children. Impacts include impairment of cognitive and behavioral development, respiratory illness, and other chronic diseases-all of which may be "seeded" in utero and affect health and functioning immediately and over the life course. By impairing children's health, ability to learn, and potential to contribute to society, pollution and climate change cause children to become less resilient and the communities they live in to become less equitable. The developing fetus and young child are disproportionately affected by these exposures because of their immature defense mechanisms and rapid development, especially those in low- and middle-income countries where poverty and lack of resources compound the effects. No country is spared, however: even high-income countries, especially low-income communities and communities of color within them, are experiencing impacts of fossil fuel-related pollution, climate change and resultant widening inequality and environmental injustice. Global pediatric health is at a tipping point, with catastrophic consequences in the absence of bold action. Fortunately, technologies and interventions are at hand to reduce and prevent pollution and climate change, with large economic benefits documented or predicted. All cultures and communities share a concern for the health and well-being of present and future children: this shared value provides a politically powerful lever for action. The purpose of this commentary is to briefly review the data on the health impacts of fossil-fuel pollution, highlighting the neurodevelopmental impacts, and to briefly describe available means to achieve a low-carbon economy, and some examples of interventions that have benefited health and the economy.

Classification of Heat-Related Illness Symptoms Among Florida Farmworkers

BACKGROUND

Farmworkers working in hot and humid environments have an increased risk for heat-related illness (HRI) if their thermoregulatory capabilities are overwhelmed. The manifestation of heat-related symptoms can escalate into life-threatening events. Increasing ambient air temperatures resulting from climate change will only exacerbate HRI in vulnerable populations. We characterize HRI symptoms experienced by farmworkers in three Florida communities.

METHODS

A total of 198 farmworkers enrolled in 2015-2016 were asked to recall if they experienced seven HRI symptoms during the previous work week. Multivariable logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for the association between selected sociodemographic characteristics and reporting three or more symptoms. Latent class analysis was used to identify classes of symptoms representing the HRI severity range. We examined sociodemographic characteristics of the farmworkers across the latent classes.

RESULTS

The mean age (±SD) of farmworkers was 38.0 (±8) years; the majority were female (60%) and Hispanic (86%). Most frequently reported symptoms were heavy sweating (66%), headache (58%), dizziness (32%), and muscle cramps (30%). Females had three times the odds of experiencing three or more symptoms (OR = 2.86, 95% CI 1.18-6.89). Symptoms fell into three latent classes, which included mild (heavy sweating; class probability = 54%), moderate (heavy sweating, headache, nausea, and dizziness; class probability = 24%), and severe (heavy sweating, headache, nausea, dizziness, muscle cramps; class probability = 22%).

CONCLUSIONS

Farmworkers reported a high burden of HRI symptoms that appear to cluster in physiologic patterns. Unrecognized accumulation of symptoms can escalate into life-threatening situations if untreated. Our research can inform interventions to promote early recognition of HRI, on-site care, and appropriate occupational health policy. Administrative or engineering workplace controls may also reduce the manifestation of HRI.

CLINICAL RELEVANCE

This study advances the current knowledge of HRI symptoms in farmworkers and moves beyond reporting individual symptoms by utilizing latent class analysis to identify how symptoms tend to co-occur together in this population. It acknowledges multiple symptoms occurring as a result of occupational heat exposure and highlights the importance of symptom recognition.

Climate Change and Public Health

It is clear that the public health community is concerned about the human health impacts of climate change, but are we inadvertently underestimating the scope of the problem and obfuscating potentially useful interventions by using a narrow intellectual frame in our discussions with policy makers? If we take a more holistic approach, we see that the public health impacts of climate change are only one subset of the enormous public health impacts of fossil fuel burning. This broader perspective can provide a more accurate and comprehensive assessment that is more useful for decision making in public policy settings.

Catalyst tolerance to SO2and water vapor of Mn based bimetallic oxides for NO deep oxidation by ozone

Improving the catalyst stabilities under different conditions (water vapor, SO₂, both water vapor and SO₂) is important for industrial applications regarding catalytic NO deep oxidation by ozone.