Social factors associated with nitrogen dioxide (NO2) exposure during pregnancy: the INMA-Valencia project in Spain

Does the perceived neighborhood environment promote mental health during pregnancy? Confirmation of a pathway through social cohesion in two Spanish samples

Physical neighborhood attributes such as greenness, walkability and environmental pollution may have an influence on people's behavior and health. It has been claimed that part of such effects may come from the promotion of physical activity and the strengthening of social cohesion. In this study, we recruited samples of pregnant women in two Spanish cities (Donostia-San Sebastián, 440 participants and Barcelona, 360 participants) who filled in a questionnaire and wore an accelerometer for 1 week during the first trimester of pregnancy. The influence of perceived residential greenness, walkability and environmental pollution on mental health (GHQ-12) was tested in two structural equation models that included light physical activity, moderate-to-vigorous physical activity and social cohesion as mediators. Two solutions showing excellent and good fits (Donostia-San Sebastián: X²(3) = 2.56, p = .465, CFI = 1, RMSEA < 0.001; Barcelona: X²(6) = 4.86, p = .566, CFI = 1, RMSEA = 0.048) consistently showed that neighborhood attributes promote mental health through social cohesion in the two cities. Stratified analyses revealed that the social cohesion-mental health effect was only statistically significant for low and medium socioeconomic status groups in the Donostia-San Sebastián sample. Pathways through physical activity were not confirmed.

Social Inequalities in Exposure to Ambient Air Pollution: A Systematic Review in the WHO European Region

Ambient air pollution is a long-standing and significant public health issue. The aim of this review is to systematically examine the peer-reviewed evidence on social inequalities and ambient air pollution in the World Health Organization European Region. Articles published between 2010 and 2017 were analyzed in the review. In total 31 articles were included in the review. There is good evidence from ecological studies that higher deprivation indices and low economic position are usually linked with higher levels of pollutants such as particulate matter (particulate matter under 2.5 and 10 microns in diameter, PM_2.5, PM₁₀) and oxides of nitrogen (e.g., NO₂, and NO_x). There is also evidence that ethnic minorities experience a mixed exposure in comparison to the majority population being sometimes higher and sometimes lower depending on the ethnic minority under consideration. The studies using data at the individual level in this review are mainly focused on pregnant women or new mothers, in these studies deprivation and ethnicity are more likely to be linked to higher exposures of poor air quality. Therefore, there is evidence in this review that the burden of higher pollutants falls disproportionally on different social groups.

Socio-Economic Status and Health: Evaluation of Human Biomonitored Chemical Exposure to Per- and Polyfluorinated Substances across Status

Research on the environment, health, and well-being nexus (EHWB) is shifting from a silo toward a systemic approach that includes the socio-economic context. To disentangle further the complex interplay between the socio-exposome and internal chemical exposure, we performed a meta-analysis of human biomonitoring (HBM) studies with internal exposure data on per-and polyfluoroalkyl substances (PFASs) and detailed information on risk factors, including descriptors of socio-economic status (SES) of the study population. PFASs are persistent in nature, and some have endocrine-disrupting properties. Individual studies have shown that HBM biomarker concentrations of PFASs generally increase with SES indicators, e.g., for income. Based on a meta-analysis (five studies) of the associations between PFASs and SES indicators, the magnitude of the association could be estimated. For the SES indicator income, changes in income were expressed by a factor change, which was corrected by the Gini coefficient to take into account the differences in income categories between studies, and the income range between countries. For the SES indicator education, we had to conclude that descriptors ( Collapse

Key Words

• HBM
• HBM4EU
• PFAS
• SES
• education
• health inequity
• human biomonitoring
• income
• socio-economic status

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MESH Headings

• Environmental Exposure
• Environmental Monitoring
• Environmental Pollutants/adverse effects
• Fluorocarbons/adverse effects
• Health Status
• Humans
• Risk Factors
• Social Class

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Affiliation(s)

Jurgen Buekers Flemish Institute for Technological Research (VITO)-Sustainable Health, 2400 Mol, Belgium.
Ann Colles Flemish Institute for Technological Research (VITO)-Sustainable Health, 2400 Mol, Belgium.
Christa Cornelis Flemish Institute for Technological Research (VITO)-Sustainable Health, 2400 Mol, Belgium.
Bert Morrens Sociology Department, University of Antwerp (UA), 2000 Antwerpen, Belgium.
Eva Govarts Flemish Institute for Technological Research (VITO)-Sustainable Health, 2400 Mol, Belgium.
Greet Schoeters Flemish Institute for Technological Research (VITO)-Sustainable Health, 2400 Mol, Belgium.

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Chinese Yellow Dust and Korean infant health

Naturally-occurring Yellow Dust outbreaks, which are produced by winds flowing to Korea from China and Mongolia, create air pollution. Although there is a seasonal pattern of this phenomenon, there exists substantial variation in its timing, strength, and location from year to year. To warn residents about air pollution in general, and about these dust storms in particular, Korean authorities issue different types of public alerts. Using birth certificate data on more than 1.5 million babies born between 2003 and 2011, we investigate the impact of air pollution, and the avoidance behavior triggered by pollution alerts on various birth outcomes. We show that air pollution rises during Yellow Dust outbreaks and that exposure to air pollution during pregnancy has a significant negative impact on birth weight, the gestation weeks of the baby, and the propensity of the baby being born low weight. Public alerts about air quality during pregnancy help mitigate the adverse effect of pollution on fetal health. The results provide evidence for the effectiveness of pollution alert systems in promoting public health. They also underline the importance of taking into account individuals' avoidance behavior when estimating the impact of air quality on birth outcomes. We show that when the preventive effect of public health warnings is not accounted for, the estimated relationship between air pollution and infant health is reduced by more than fifty percent. In summary, air pollution has a deteriorating impact on newborns' health, and public alerts that warn individuals about increased air pollution help alleviate the negative impact.

Socioeconomic position and outdoor nitrogen dioxide (NO2) exposure in Western Europe: A multi-city analysis

BACKGROUND

Inconsistent associations between socioeconomic position (SEP) and outdoor air pollution have been reported in Europe, but methodological differences prevent any direct between-study comparison.

OBJECTIVES

Assess and compare the association between SEP and outdoor nitrogen dioxide (NO₂) exposure as a marker of traffic exhaust, in 16 cities from eight Western European countries.

METHODS

Three SEP indicators, two defined at individual-level (education and occupation) and one at neighborhood-level (unemployment rate) were assessed in three European multicenter cohorts. NO₂ annual concentration exposure was estimated at participants' addresses with land use regression models developed within the European Study of Cohorts for Air Pollution Effects (ESCAPE; http://www.escapeproject.eu/). Pooled and city-specific linear regressions were used to analyze associations between each SEP indicator and NO₂. Heterogeneity across cities was assessed using the Higgins' I-squared test (I²).

RESULTS

The study population included 5692 participants. Pooled analysis showed that participants with lower individual-SEP were less exposed to NO₂. Conversely, participants living in neighborhoods with higher unemployment rate were more exposed. City-specific results exhibited strong heterogeneity (I²>76% for the three SEP indicators) resulting in variation of the individual- and neighborhood-SEP patterns of NO₂ exposure across cities. The coefficients from a model that included both individual- and neighborhood-SEP indicators were similar to the unadjusted coefficients, suggesting independent associations.

CONCLUSIONS

Our study showed for the first time using homogenized measures of outcome and exposure across 16 cities the important heterogeneity regarding the association between SEP and NO₂ in Western Europe. Importantly, our results showed that individual- and neighborhood-SEP indicators capture different aspects of the association between SEP and exposure to air pollution, stressing the importance of considering both in air pollution health effects studies.

Association between prenatal exposure to traffic-related air pollution and preterm birth in the PELAGIE mother-child cohort, Brittany, France. Does the urban-rural context matter?

INTRODUCTION

Evidence has accumulated that exposure to ambient air pollution during pregnancy may influence preterm birth (PTB) in urban settings. Conversely, this relation has barely been investigated in rural areas where individual characteristics (demographic, socioeconomic, and psychosocial factors) and environmental co-exposures may differ.

OBJECTIVE

We examined the association between prenatal exposure to traffic-related air pollution and PTB among pregnant women from the PELAGIE mother-child cohort (Brittany, France, 2002-2006) living in urban (n=1550) and rural (n=959) settings.

METHODS

Women's residences were classified as either urban or rural according to the French census bureau rural-urban definitions. Nitrogen dioxide (NO2) concentrations at home addresses were estimated from adjusted land-use regression models as a marker of traffic-related pollution. Associations between NO2 concentrations and PTB were assessed with logistic regression models.

RESULTS

Prevalence of PTB was similar among women living in urban (3.2%) and in rural (3.5%) settings. More positive socioeconomic characteristics and health behaviors but more single-parent families were observed among urban women. NO2 exposure averaged 20.8±6.6 µg m(-3) for women residing in urban areas and 18.8±5.6 µg m(-3) for their rural counterparts. A statistically significant increased risk of PTB was observed among women exposed to NO2 concentrations ≥16.4 µg m(-3) and residing in urban areas but not among their rural counterparts.

DISCUSSION

The results of this study, conducted in a region with interspersed urban-rural areas, are in line with previous findings suggesting an increased risk of PTB associated with higher NO2 concentrations for women living in urban areas. The absence of association among their rural counterparts for whom exposure levels were similar suggests that environmental mixtures and psychosocial inequalities might play a role in this heterogeneity.

The health burden of pollution: the impact of prenatal exposure to air pollutants

Exposure to atmospheric pollutants in both open and closed environments is a major cause of morbidity and mortality that may be both controlled and minimized. Despite growing evidence, several controversies and disagreements exist among the studies that have analyzed the effects of prenatal pollutant exposure. This review article aims to analyze primary scientific evidence of the effects of air pollution during pregnancy and the impact of these effects on the fetus, infant health, and in particular, the respiratory system. We performed a review of articles from the PubMed and Web of Science databases that were published in English within the past 5 years, particularly those related to birth cohorts that began in pregnancy with follow-up until the first years of life. The largest reported effects are associated with prenatal exposure to particulate matter, nitrogen dioxide, and tobacco smoke. The primary effects affect birth weight and other parameters of fetal biometry. There is strong evidence regarding the impact of pollutants on morbidity secondary to respiratory problems. Growing evidence links maternal smoking to childhood asthma and wheezing. The role of passive maternal smoking is less clear. Great heterogeneity exists among studies. There is a need for additional studies on birth cohorts to monitor the relationship between the exposure of pregnant women to pollutants and their children’s progress during the first years of life.

Socioeconomic status and exposure to outdoor NO2 and benzene in the Asturias INMA birth cohort, Spain

Background

It is commonly assumed that low socioeconomic levels are associated with greater exposure to pollution, but this is not necessarily valid. Our goal was to examine how individual socioeconomic characteristics are associated with exposure levels in a Spanish region included in the INfancia y Medio Ambiente (INMA) cohort.

Methods

The study population comprised 430 pregnant women from the Asturias INMA cohort. Air pollution exposure was estimated using land-use regression techniques. Information about the participants’ lifestyle and socioeconomic variables was collected through questionnaires. In multivariate analysis, the levels of NO₂ and benzene assigned to each woman were considered as dependent variables. Other variables included in the models were residential zone, age, education, parity, smoking, season, working status during pregnancy and social class.

Results

The average NO₂ level was 23.60 (SD=6.50) μg/m³. For benzene, the mean value was 2.31 (SD=1.32) μg/m³. We found no association of any pollutant with education. We observed an association between social class and benzene levels. Social classes I and II had the highest levels. The analysed socioeconomic and lifestyle variables accounted for little variability in air pollution in the models; this variability was explained mainly by residential zone (adjusted R²: 0.27 for NO₂; 0.09 for benzene).

Conclusions

Education and social class were not clearly associated with pollution. Administrations should monitor the environment of residential areas regardless of the socioeconomic level, and they should increase the distances between housing and polluting sources to prevent settlements at distances that are harmful to health.

A comparison of population air pollution exposure estimation techniques with personal exposure estimates in a pregnant cohort

There is increasing evidence of the harmful effects for mother and fetus of maternal exposure to air pollutants. Most studies use large retrospective birth outcome datasets and make a best estimate of personal exposure (PE) during pregnancy periods. We compared estimates of personal NOx and NO2 exposure of pregnant women in the North West of England with exposure estimates derived using different modelling techniques. A cohort of 85 pregnant women was recruited from Manchester and Blackpool. Participants completed a time-activity log and questionnaire at 13-22 weeks gestation and were provided with personal Ogawa samplers to measure their NOx/NO2 exposure. PE was compared to monthly averages, the nearest stationary monitor to the participants' home, weighted average of the closest monitor to home and work location, proximity to major roads, as well as to background modelled concentrations (DEFRA), inverse distance weighting (IDW), ordinary kriging (OK), and a land use regression model with and without temporal adjustment. PE was most strongly correlated with monthly adjusted DEFRA (NO2r = 0.61, NOxr = 0.60), OK and IDW (NO2r = 0.60; NOxr = 0.62) concentrations. Correlations were stronger in Blackpool than in Manchester. Where there is evidence for high temporal variability in exposure, methods of exposure estimation which focus solely on spatial methods should be adjusted temporally, with an improvement in estimation expected to be better with increased temporal variability.