The impact of daily mobility on exposure to traffic-related air pollution and health effect estimates

Air pollution exposure in active versus passive travel modes across five continents: A Bayesian random-effects meta-analysis

Epidemiological studies on health effects of air pollution usually estimate exposure at the residential address. However, ignoring daily mobility patterns may lead to biased exposure estimates, as documented in previous exposure studies. To improve the reliable integration of exposure related to mobility patterns into epidemiological studies, we conducted a systematic review of studies across all continents that measured air pollution concentrations in various modes of transport using portable sensors. To compare personal exposure across different transport modes, specifically active versus motorized modes, we estimated pairwise exposure ratios using a Bayesian random-effects meta-analysis. Overall, we included measurements of six air pollutants (black carbon (BC), carbon monoxide (CO), nitrogen dioxide (NO2), particulate matter (PM10, PM2.5) and ultrafine particles (UFP)) for seven modes of transport (i.e., walking, cycling, bus, car, motorcycle, overground, underground) from 52 published studies. Compared to active modes, users of motorized modes were consistently the most exposed to gaseous pollutants (CO and NO2). Cycling and walking were the most exposed to UFP compared to other modes. Active vs passive mode contrasts were mostly inconsistent for other particle metrics. Compared to active modes, bus users were consistently more exposed to PM10 and PM2.5, while car users, on average, were less exposed than pedestrians. Rail modes experienced both some lower exposures (compared to cyclists for PM10 and pedestrians for UFP) and higher exposures (compared to cyclist for PM2.5 and BC). Ratios calculated for motorcycles should be considered carefully due to the small number of studies, mostly conducted in Asia. Computing exposure ratios overcomes the heterogeneity in pollutant levels that may exist between continents and countries. However, formulating ratios on a global scale remains challenging owing to the disparities in available data between countries.

The impact of exposure assessment on associations between air pollution and cardiovascular mortality risks in the city of Rio de Janeiro, Brazil

Despite a growing literature for complex air quality models, scientific evidence lacks of the influences of varying exposure assessments and air quality data sources on the estimated mortality risks. This case-crossover study estimated cardiovascular mortality risks from fine particulate matter (PM2.5) and ozone (O3) exposures, using varying exposure methods, to aid understanding of the impact of exposure methods in the health risk estimation. We used individual-level cardiovascular mortality data in the city of Rio de Janeiro, 2012-2016. PM2.5 and O3 exposure levels (from the date of death to seven prior days [lag0-7]) were estimated at the individual level or district level using either the WRF-Chem modeling data or monitoring data, resulting in a total of 10 exposure methods. The exposure-response relationships were estimated using multiple logistic regressions. The changes in cardiovascular mortality were represented as an odds ratio (OR) and 95% confidence intervals (CIs) for an interquartile range (IQR) increase in the exposures. Results showed that socioeconomically more advantaged populations had lower access to the stationary monitoring networks. Higher variance in the estimated exposure levels across the 10 exposure methods was found for PM2.5 than O3. PM2.5 exposure was not associated with mortality risk in any exposure methods. WRF-Chem-based O3 exposure estimated for each individual of the entire population found a significant mortality risk (OR = 1.06, 95% CI: 1.01, 1.11), but not the other exposure methods. Higher risks for females and older populations were suggested for O3 estimates estimated for each individual using the WRF-Chem data. Findings indicate that decisions on exposure methods and data sources can lead to substantially varying implications for air pollution risks and highlight the need for comprehensive exposure and health impact assessments to aid local decision-making for air pollution and public health.

How mobility pattern shapes the association between static green space and dynamic green space exposure

Greenspaces are crucial for enhancing mental and physical health. Recent research has shifted from static methods of assessing exposure to greenspaces, based on fixed locations, to dynamic approaches that account for individual mobility. These dynamic evaluations utilize advanced technologies like GPS tracking and remote sensing to provide more precise exposure estimates. However, little work has been conducted to compare dynamic and static exposure assessments and the effect of individual mobility on these evaluations. This study delves into how greenspaces around homes and workplaces, along with mobility patterns, affect dynamic greenspace exposure in Hong Kong. Data was collected from 787 participants in four communities in Hong Kong using GPS, portable sensors, and surveys. Using multiple statistical tests, our study revealed significant variations in participants' daily mobility patterns across socio-demographic and temporal factors. Further, using linear mixed-effects models, we identified complex and statistically significant interactions between participants' static greenspace exposure and their mobility patterns. Our findings suggest that individual mobility patterns significantly modify the relationship between static and dynamic greenspace exposure and play a critical role in explaining socio-demographic and temporal context differences in the relationship between static and dynamic greenspace exposure.

Does residential address-based exposure assessment for outdoor air pollution lead to bias in epidemiological studies?

BACKGROUND

Epidemiological studies of long-term exposure to outdoor air pollution have consistently documented associations with morbidity and mortality. Air pollution exposure in these epidemiological studies is generally assessed at the residential address, because individual time-activity patterns are seldom known in large epidemiological studies. Ignoring time-activity patterns may result in bias in epidemiological studies. The aims of this paper are to assess the agreement between exposure assessed at the residential address and exposures estimated with time-activity integrated and the potential bias in epidemiological studies when exposure is estimated at the residential address.

MAIN BODY

We reviewed exposure studies that have compared residential and time-activity integrated exposures, with a focus on the correlation. We further discuss epidemiological studies that have compared health effect estimates between the residential and time-activity integrated exposure and studies that have indirectly estimated the potential bias in health effect estimates in epidemiological studies related to ignoring time-activity patterns. A large number of studies compared residential and time-activity integrated exposure, especially in Europe and North America, mostly focusing on differences in level. Eleven of these studies reported correlations, showing that the correlation between residential address-based and time-activity integrated long-term air pollution exposure was generally high to very high (R > 0.8). For individual subjects large differences were found between residential and time-activity integrated exposures. Consistent with the high correlation, five of six identified epidemiological studies found nearly identical health effects using residential and time-activity integrated exposure. Six additional studies in Europe and North America showed only small to moderate potential bias (9 to 30% potential underestimation) in estimated exposure response functions using residence-based exposures. Differences of average exposure level were generally small and in both directions. Exposure contrasts were smaller for time-activity integrated exposures in nearly all studies. The difference in exposure was not equally distributed across the population including between different socio-economic groups.

CONCLUSIONS

Overall, the bias in epidemiological studies related to assessing long-term exposure at the residential address only is likely small in populations comparable to those evaluated in the comparison studies. Further improvements in exposure assessment especially for large populations remain useful.

The Association Between Personal Air Pollution Exposures and Fractional Exhaled Nitric Oxide (FeNO): A Systematic Review

PURPOSE OF REVIEW

Airway inflammation is a common biological response to many types of environmental exposures and can lead to increased nitric oxide (NO) concentrations in exhaled breath. In recent years, several studies have evaluated airway inflammation using fractional exhaled nitric oxide (FeNO) as a biomarker of exposures to a range of air pollutants. This systematic review aims to summarize the studies that collected personal-level air pollution data to assess the air pollution-induced FeNO responses and to determine if utilizing personal-level data resulted in an improved characterization of the relationship between air pollution exposures and FeNO compared to using only ambient air pollution exposure data.

RECENT FINDINGS

Thirty-six eligible studies were identified. Overall, the studies included in this review establish that an increase in personal exposure to particulate and gaseous air pollutants can significantly increase FeNO. Nine out of the 12 studies reported statistically significant FeNO increases with increasing personal PM2.5 exposures, and up to 11.5% increase in FeNO per IQR increase in exposure has also been reported between FeNO and exposure to gas-phase pollutants, such as ozone, NO2, and benzene. Furthermore, factors such as chronic respiratory diseases, allergies, and medication use were found to be effect modifiers for air pollution-induced FeNO responses. About half of the studies that compared the effect estimates using both personal and ambient air pollution exposure methods reported that only personal exposure yielded significant associations with FeNO response. The evidence from the reviewed studies confirms that FeNO is a sensitive biomarker for air pollutant-induced airway inflammation. Personal air pollution exposure assessment is recommended to accurately assess the air pollution-induced FeNO responses. Furthermore, comprehensive adjustments for the potential confounding factors including the personal exposures of the co-pollutants, respiratory disease status, allergy status, and usage of medications for asthma and allergies are recommended while assessing the air pollution-induced FeNO responses.

Assessing the 2023 Canadian wildfire smoke impact in Northeastern US: Air quality, exposure and environmental justice

The Canadian wildfires in June 2023 significantly impacted the northeastern United States, particularly in terms of worsened air pollution and environmental justice concerns. While advancements have been made in low-cost sensor deployments and satellite observations of atmospheric composition, integrating dynamic human mobility with wildfire PM2.5 exposure to fully understand the environmental justice implications remains underinvestigated. This study aims to enhance the accuracy of estimating ground-level fine particulate matter (PM2.5) concentrations by fusing chemical transport model outputs with empirical observations, estimating exposures using human mobility data, and evaluating the impact of environmental justice. Employing a novel data fusion technique, the study combines the Weather Research and Forecasting model with Chemistry (WRF-Chem) outputs and surface PM2.5 measurements, providing a more accurate estimation of PM2.5 distribution. The study addresses the gap in traditional exposure assessments by incorporating human mobility data and further investigates the spatial correlation of PM2.5 levels with various environmental and demographic factors from the US Environmental Protection Agency (EPA) Environmental Justice Screening and Mapping Tool (EJScreen). Results reveal that despite reduced mobility during high PM2.5 levels from wildfire smoke, exposure for both residents and individuals on the move remains high. Regions already burdened with high environmental pollution levels face amplified PM2.5 effects from wildfire smoke. Furthermore, we observed mixed correlations between PM2.5 concentrations and various demographic and socioeconomic factors, indicating complex exposure patterns across communities. Urban areas, in particular, experience persistent high exposure, while significant correlations in rural areas with EJScreen factors highlight the unique vulnerabilities of these populations to smoke exposure. These results advocate for a comprehensive approach to environmental health that leverages advanced models, integrates human mobility data, and addresses socio-demographic disparities, contributing to the development of equitable strategies against the growing threat of wildfires.

Assessment of air pollution and air quality perception mismatch using mobility-based real-time exposure

Air pollution poses a threat to human health. Public perceptions of air pollution are important for individual self-protection and policy-making. Given the uncertainty faced by residence-based exposure (RB) measurements, this study measures individuals' real-time mobility-based (MB) exposures and perceptions of air pollution by considering people's daily movement. It explores how contextual uncertainties may influence the disparities in perceived air quality by taking into account RB and MB environmental factors. In addition, we explore factors that are related to the mismatch between people's perceived air quality and actual air pollution exposure. Using K-means clustering to divide the PM2.5 values into two groups, a mismatch happens when the perceived air quality is poor but the air pollution level is lower than 15.536μg/m3 and when the perceived air quality is good but the air pollution level is higher than 15.608μg/m3. The results show that there is a mismatch between air pollution exposure and perception of air pollution. People with low income are exposed to higher air pollution. Unemployed people and people with more serious mental health symptoms (e.g., depression) have a higher chance of accurately assessing air pollution (e.g., perceiving air quality as poor when air pollution levels are high). Older people and those with a higher MB open space density tend to underestimate air pollution. Students tend to perceive air quality as good. People who are surrounded by higher MB transportation land-use density and green space density tend to perceive air quality as poor. The results can help policymakers to increase public awareness of high air pollution areas, and consider the health effects of landscapes during planning.

Quantifying Disparities in Air Pollution Exposures across the United States Using Home and Work Addresses

While human mobility plays a crucial role in determining ambient air pollution exposures and health risks, research to date has assessed risks on the basis of almost solely residential location. Here, we leveraged a database of ∼128-144 million workers in the United States and published ambient PM2.5 data between 2011 and 2018 to explore how incorporating information on both workplace and residential location changes our understanding of disparities in air pollution exposure. In general, we observed higher workplace exposures relative to home exposures, as well as increased exposures for nonwhite and less educated workers relative to the national average. Workplace exposure disparities were higher among racial and ethnic groups and job types than by income, education, age, and sex. Not considering workplace exposures can lead to systematic underestimations in disparities in exposure among these subpopulations. We also quantified the error in assigning workers home instead of a weighted home-and-work exposure. We observed that biases in associations between PM2.5 and health impacts by using home instead of home-and-work exposure were the highest among urban, younger populations.

Exploring Regional Reduction Pathways for Human Exposure to Fine Particulate Matter (PM2.5) Using a Traffic Assignment Model

An exposure-based traffic assignment (TA) model is used to quantify primary and secondary fine particulate matter (PM2.5) exposure from on-road vehicle flow on the Chicago Metropolitan Area regional network. PM2.5 exposure due to emissions from light-duty vehicles, heavy-duty trucks, public transportation, and electricity generation for electric vehicle charging and light-rail transportation is considered. The model uses travel demand data disaggregated by time-of-day period and vehicle user class to compare the exposure impacts of two TA optimization scenarios: a baseline user equilibrium with respect to travel time (UET) and a system optimal with respect to pollutant intake (SOI). Estimated baseline PM2.5 exposure damages are $3.7B-$8.3B/year. The SOI uses exposure-based vehicle rerouting to reduce total damages by 8.2%, with high-impacted populations benefiting from 10% to 20% reductions. However, the SOI's rerouting principle leads to a 66% increase in travel time. The model is then used to quantify the mitigation potential of different exposure reduction strategies, including a bi-objective optimization formulation that minimizes travel time and PM2.5 exposure concurrently, adoption of a cleaner vehicle fleet, higher public transportation use, particle filtration, and exposure-based truck routing. Exposure reductions range between 1% and 40%, but collective adoption of all strategies would lead to reductions upward of 50%.

Cyclists' exposure to air pollution, noise, and greenery: a population-level spatial analysis approach

Urban travel exposes people to a range of environmental qualities with significant health and wellbeing impacts. Nevertheless, the understanding of travel-related environmental exposure has remained limited. Here, we present a novel approach for population-level assessment of multiple environmental exposure for active travel. It enables analyses of (1) urban scale exposure variation, (2) alternative routes' potential to improve exposure levels per exposure type, and (3) by combining multiple exposures. We demonstrate the approach's feasibility by analysing cyclists' air pollution, noise, and greenery exposure in Helsinki, Finland. We apply an in-house developed route-planning and exposure assessment software and integrate to the analysis 3.1 million cycling trips from the local bike-sharing system. We show that especially noise exposure from cycling exceeds healthy thresholds, but that cyclists can influence their exposure by route choice. The proposed approach enables planners and individual citizens to identify (un)healthy travel environments from the exposure perspective, and to compare areas in respect to how well their environmental quality supports active travel. Transferable open tools and data further support the implementation of the approach in other cities.

Association between Exposure to Particulate Matter Air Pollution during Early Childhood and Risk of Attention-Deficit/Hyperactivity Disorder in Taiwan

(1) Background: Recently, a growing number of studies have provided evidence to suggest a strong correlation between air pollution exposure and attention-deficit/hyperactivity disorder (ADHD). In this study, we assessed the relationship between early-life exposure to particulate matter (PM)₁₀, PM₂.₅, and ADHD; (2) Methods: The National Health Insurance Research Database (NHIRD) contains the medical records, drug information, inspection data, etc., of the people of Taiwan, and, thus, could serve as an important research resource. Air pollution data were based on daily data from the Environmental Protection Administration Executive Yuan, R.O.C. (Taiwan). These included particulate matter (PM_2.5 and PM₁₀). The two databases were merged according to the living area of the insured and the location of the air quality monitoring station; (3) Results: The highest levels of air pollutants, including PM_2.5 (adjusted hazard ratio (aHR) = 1.79; 95% confidence interval (CI) = 1.58-2.02) and PM₁₀ (aHR = 1.53; 95% CI = 1.37-1.70), had a significantly higher risk of ADHD; (4) Conclusions: As such, measures for air quality control that meet the WHO air quality guidelines should be strictly and uniformly implemented by Taiwanese government authorities.

Bring Your Own Location Data: Use of Google Smartphone Location History Data for Environmental Health Research

BACKGROUND

Environmental exposures are commonly estimated using spatial methods, with most epidemiological studies relying on home addresses. Passively collected smartphone location data, like Google Location History (GLH) data, may present an opportunity to integrate existing long-term time-activity data.

OBJECTIVES

We aimed to evaluate the potential use of GLH data for capturing long-term retrospective time-activity data for environmental health research.

METHODS

We included 378 individuals who participated in previous Global Positioning System (GPS) studies within the Washington State Twin Registry. GLH data consists of location information that has been routinely collected since 2010 when location sharing was enabled within android operating systems or Google apps. We created instructions for participants to download their GLH data and provide it through secure data transfer. We summarized the GLH data provided, compared it to available GPS data, and conducted an exposure assessment for nitrogen dioxide (NO2) air pollution.

RESULTS

Of 378 individuals contacted, we received GLH data from 61 individuals (16.1%) and 53 (14.0%) indicated interest but did not have historical GLH data available. The provided GLH data spanned 2010-2021 and included 34 million locations, capturing 66,677 participant days. The median number of days with GLH data per participant was 752, capturing 442 unique locations. When we compared GLH data to 2-wk GPS data (∼1.8 million points), 95% of GPS time-activity points were within 100m of GLH locations. We observed important differences between NO2 exposures assigned at home locations compared with GLH locations, highlighting the importance of GLH data to environmental exposure assessment.

DISCUSSION

We believe collecting GLH data is a feasible and cost-effective method for capturing retrospective time-activity patterns for large populations that presents new opportunities for environmental epidemiology. Cohort studies should consider adding GLH data collection to capture historical time-activity patterns of participants, employing a "bring-your-own-location-data" citizen science approach. Privacy remains a concern that needs to be carefully managed when using GLH data. https://doi.org/10.1289/EHP10829.

Agent-based modeling of urban exposome interventions: prospects, model architectures, and methodological challenges

With ever more people living in cities worldwide, it becomes increasingly important to understand and improve the impact of the urban habitat on livability, health behaviors, and health outcomes. However, implementing interventions that tackle the exposome in complex urban systems can be costly and have long-term, sometimes unforeseen, impacts. Hence, it is crucial to assess the health impact, cost-effectiveness, and social distributional impacts of possible urban exposome interventions (UEIs) before implementing them. Spatial agent-based modeling (ABM) can capture complex behavior-environment interactions, exposure dynamics, and social outcomes in a spatial context. This article discusses model architectures and methodological challenges for successfully modeling UEIs using spatial ABM. We review the potential and limitations of the method; model components required to capture active and passive exposure and intervention effects; human-environment interactions and their integration into the macro-level health impact assessment and social costs benefit analysis; and strategies for model calibration. Major challenges for a successful application of ABM to UEI assessment are (1) the design of realistic behavioral models that can capture different types of exposure and that respond to urban interventions, (2) the mismatch between the possible granularity of exposure estimates and the evidence for corresponding exposure-response functions, (3) the scalability issues that emerge when aiming to estimate long-term effects such as health and social impacts based on high-resolution models of human-environment interactions, (4) as well as the data- and computational complexity of calibrating the resulting agent-based model. Although challenges exist, strategies are proposed to improve the implementation of ABM in exposome research.

Reductions in NO2 and emergency room visits associated with California's goods movement policies: A quasi-experimental study

INTRODUCTION

This study examines whether the "Emission Reduction Plan for Ports and Goods Movement" in California reduced air pollution exposures and emergency room visits among California Medicaid enrollees with asthma and/or chronic obstructive pulmonary disease.

METHOD

We created a retrospective cohort of 5608 Medicaid enrollees from ten counties in California with data from 2004 to 2010. We grouped the patients into two groups: those living within 500 m of goods movement corridors (ports and truck-permitted freeways), and control areas (away from the busy truck or car permitted highways). We created annual air pollution surfaces for nitrogen dioxide and assigned them to enrollees' home addresses. We used a quasi-experimental design with a difference-in-differences method to examine changes before and after the policy for cohort beneficiaries in the two groups.

RESULTS

The reductions in nitrogen dioxide exposures and emergency room visits were greater for enrollees in goods movement corridors than those in control areas in post-policy years. We found that the goods movement actions were associated with 14.8% (95% CI, -24.0% to -4.4%; P = 0.006) and 11.8% (95% CI, -21.2% to -1.2%; P = 0.030) greater reduction in emergency room visits for the beneficiaries with asthma and chronic obstructive pulmonary disease, respectively, in the third year after California's emission reduction plan.

CONCLUSION

These findings indicate remarkable health benefits via reduced emergency room visits from the significantly improved air quality due to public policy interventions for disadvantaged and susceptible populations.

Postnatal exposure to ambient air pollutants is associated with the composition of the infant gut microbiota at 6-months of age

Epidemiological studies in adults have shown that exposure to ambient air pollution (AAP) is associated with the composition of the adult gut microbiome, but these relationships have not been examined in infancy. We aimed to determine if 6-month postnatal AAP exposure was associated with the infant gut microbiota at 6 months of age in a cohort of Latino mother-infant dyads from the Southern California Mother's Milk Study (n = 103). We estimated particulate matter (PM_2.5 and PM₁₀) and nitrogen dioxide (NO₂) exposure from birth to 6-months based on residential address histories. We characterized the infant gut microbiota using 16S rRNA amplicon sequencing at 6-months of age. At 6-months, the gut microbiota was dominated by the phyla Bacteroidetes, Firmicutes, Proteobacteria, and Actinobacteria. Our results show that, after adjusting for important confounders, postnatal AAP exposure was associated with the composition of the gut microbiota. As an example, PM₁₀ exposure was positively associated with Dialister, Dorea, Acinetobacter, and Campylobacter while PM_2.5 was positively associated with Actinomyces. Further, exposure to PM₁₀ and PM_2.5 was inversely associated with Alistipes and NO₂ exposure was positively associated with Actinomyces, Enterococcus, Clostridium, and Eubacterium. Several of these taxa have previously been linked with systemic inflammation, including the genera Dialister and Dorea. This study provides the first evidence of significant associations between exposure to AAP and the composition of the infant gut microbiota, which may have important implications for future infant health and development.

Exposure to Traffic Density during Pregnancy and Birth Weight in a National Cohort, 2000-2017

The variation on birth weight is associated with several outcomes early on in life and low birth weight (LBW) increases the risk of morbidity and mortality. Some environmental exposures during pregnancy, such as particulate matters and other traffic-related pollutants can have a significant effect on pregnant women and fetuses. The aim of this study is to estimate the effect of exposure to traffic density during pregnancy over birth weight in Spain, from 2000-2017. This was a retrospective, cross-sectional study using the information from Spain Birth Registry Statistics database. The traffic density was measured using the Annual average daily traffic. Multivariate linear regression models using birth weight and traffic density were performed, as well as a logistic regression model to estimated Odds ratios for LBW and GAM models to evaluate the non-linear effect. Our findings showed that increases in traffic density were associated with reduction of birth weight and increases of LBW risk. Moreover, exposure to high and very-high traffic-density during pregnancy were associated with reduction of birth weight and increase on LBW risk comparing with exposure to low number of cars trespassing the neighborhoods. The results of this study agree with previous literature and highlights the need of effective policies for reducing traffic density in residential neighborhoods of cities and towns.

Spatiotemporal Distribution Patterns and Exposure Risks of PM2.5 Pollution in China

The serious pollution of PM2.5 caused by rapid urbanization in recent years has become an urgent problem to be solved in China. Annual and daily satellite-derived PM2.5 datasets from 2001 to 2020 were used to analyze the temporal and spatial patterns of PM2.5 in China. The regional and population exposure risks of the nation and of urban agglomerations were evaluated by exceedance frequency and population weight. The results indicated that the PM2.5 concentrations of urban agglomerations decreased sharply from 2014 to 2020. The region with PM2.5 concentrations less than 35 μg·m−3 accounted for 80.27% in China, and the average PM2.5 concentrations in 8 urban agglomerations were less than 35 μg·m−3 in 2020. The spatial distribution pattern of PM2.5 concentrations in China revealed higher concentrations to the east of the Hu Line and lower concentrations to the west. The annual regional exposure risk (RER) in China was at a high level, with a national average of 0.75, while the average of 14 urban agglomerations was as high as 0.86. Among the 14 urban agglomerations, the average annual RER was the highest in the Shandong Peninsula (0.99) and lowest in the Northern Tianshan Mountains (0.76). The RER in China has obvious seasonality; the most serious was in winter, and the least serious was in summer. The population exposure risk (PER) east of the Hu Line was significantly higher than that west of the Hu Line. The average PER was the highest in Beijing-Tianjin-Hebei (4.09) and lowest in the Northern Tianshan Mountains (0.71). The analysis of air pollution patterns and exposure risks in China and urban agglomerations in this study could provide scientific guidance for cities seeking to alleviate air pollution and prevent residents’ exposure risks.

Air pollution and metabolic disorders: Dynamic versus static measures of exposure among Hispanics/Latinos and non-Hispanics

INTRODUCTION

Exposure to air pollution disproportionately affects racial/ethnic minorities that could contribute to health inequalities including metabolic disorders. However, most existing studies used a static assessment of air pollution exposure (mostly using the residential address) and do not account for activity space when modelling exposure to air pollution. The aim of this study is to understand how exposure to air pollution impacts metabolic disorders biomarkers, how this effect differs according to ethnicity, and for the first time compare these findings with two methods of exposure assessment: dynamic and static measures.

METHODS

Among the Community of Mine study, a cross-sectional study conducted in San Diego County, insulin resistance, diabetes, hypertension, obesity, dyslipidemia, and metabolic syndrome (MetS) were assessed. Exposure to air pollution (PM_2.5, NO₂, traffic) was calculated using static measures around the home, and dynamic measures of mobility derived from Global Positioning Systems (GPS) traces using kernel density estimators to account for exposure variability across space and time. Associations of air pollution with metabolic disorders were quantified using generalized estimating equation models to account for the clustered nature of the data.

RESULTS

Among 552 participants (mean age 58.7 years, 42% Hispanic/Latino), Hispanics/Latinos had a higher exposure to PM_2.5 compared to non-Hispanics using static measures. In contrast, Hispanics/Latinos had less exposure to PM_2.5 using dynamic measures. For all participants, higher dynamic exposure to PM_2.5 and NO₂ was associated with increased insulin resistance and cholesterol levels, and increased risk of obesity, dyslipidemia and MetS (RR 1.17, 95% CI: 1.07-1.28; RR 1.21, 95% CI: 1.12-1.30, respectively). The association between dynamic PM_2.5 exposure and MetS differed by Hispanic/Latino ethnicity.

CONCLUSION

These results highlight the importance of considering people's daily mobility in assessing the impact of air pollution on health.

Exposed to NO2 in the center, NOx polluters in the periphery: Evidence from the Paris region

Air pollution is the cause of many health problems. In cities, combustion vehicles are a major contributor to emissions of key air pollutants. While many studies have focused on populations exposed to pollutants and the resulting environmental and social inequalities, few compare exposures and contributions. In this research, the population of the Household Travel Survey of the Paris region is studied by confronting two elements: the average individual exposure to NO₂ during an average working day and the average traffic NO_x emitted during a day by the motorized trips for each resident surveyed. The dynamic exposure to NO₂ of each resident is estimated according to activities in an average working day. The results confirm an environmental inequality according to the place of residence: on average, the center residents contribute little to pollutant emissions but are highly exposed. Some categories of the population, including women and the socially disadvantaged, are the most affected by these inequalities.

Personal exposure to concentrations and inhalation of black carbon according to transport mode use: The MobiliSense sensor-based study

INTRODUCTION

Epidemiological evidence suggests that motorized vehicle users have a higher air pollutant exposure (especially from vehicle exhaust) than active (walking or cycling) transport users. However, studies often relied on insufficiently diverse sample and ignored that minute ventilation has an effect on individuals' inhaled dose. This study examined commuters' breathing zone concentration and inhaled doses of black carbon (BC) when travelling by different transport modes in the Grand Paris region.

METHODS

Personal exposure to BC was continuously measured with MicroAethalometer (MicroAeth AE51) portable monitors strapped on participants' shoulder with tube inlet at the level of the neck (breathing zone), and inhaled doses were derived from several methods estimating ventilation [based on metabolic equivalents from accelerometry [METs], heart rate, and breathing rate]. Trip stages and transport modes were assessed from GPS and mobility survey data. Breathing zone concentrations and inhaled doses of BC were compared across transport modes at the trip stage level (n = 7495 for 283 participants) using linear mixed effect models with a random intercept at individual level.

RESULTS

Trip stages involving public transport and private motorized transport were associated with a 2.20 µg/m³ (95% CI: 1.99, 2.41) and 2.29 µg/m³ (95% CI: 2.10, 2.48) higher breathing zone concentration to BC than walking, respectively. Trip stages with other active modes had a 0.41 µg (95% CI: 0.25, 0.57) higher inhaled dose, while those involving public transport and private motorized transport had a 0.25 µg (95% CI: -0.35, -0.15) and 0.19 µg (95 %CI: -0.28, -0.10) lower inhaled dose of BC per 30 min than walking.

CONCLUSION

The ranking of transport modes in terms of personal exposure was markedly different when breathing zone concentrations and inhaled doses were considered. Future studies should take both into account to explore the relationship of air pollutants in transport microenvironments with physiological response.

The influence of outdoor PM2.5 concentration at workplace on nonaccidental mortality estimates in a Canadian census-based cohort

Background

Associations between mortality and exposure to ambient air pollution are usually explored using concentrations of residential outdoor fine particulate matter (PM_2.5) to estimate individual exposure. Such studies all have an important limitation in that they do not capture data on individual mobility throughout the day to areas where concentrations may be substantially different, leading to possible exposure misclassification. We examine the possible role of outdoor PM_2.5 concentrations at work for a large population-based mortality cohort.

Methods

Using the 2001 Canadian Census Health and Environment Cohort (CanCHEC), we created a time-weighted average that incorporates employment hours worked in the past week and outdoor PM_2.5 concentration at work and home. We used a Cox proportional hazard model with a 15-year follow-up (2001 to 2016) to explore whether inclusion of workplace estimates had an impact on hazard ratios for mortality for this cohort.

Results

Hazard ratios relying on outdoor PM_2.5 concentration at home were not significantly different from those using a time-weighted estimate, for the full cohort, nor for those who commute to a regular workplace. When exploring cohort subgroups according to neighborhood type and commute distance, there was a notable but insignificant change in risk of nonaccidental death for those living in car-oriented neighborhoods, and with commutes greater than 10 km.

Conclusions

Risk analyses performed with large cohorts in low-pollution environments do not seem to be biased if relying solely on outdoor PM_2.5 concentrations at home to estimate exposure.

A comparison of associations with childhood lung function between air pollution exposure assessment methods with and without accounting for time-activity patterns

BACKGROUND

To investigate associations between annual average air pollution exposures and health, most epidemiological studies rely on estimated residential exposures because information on actual time-activity patterns can only be collected for small populations and short periods of time due to costs and logistic constraints. In the current study, we aim to compare exposure assessment methodologies that use data on time-activity patterns of children with residence-based exposure assessment. We compare estimated exposures and associations with lung function for residential exposures and exposures accounting for time activity patterns.

METHODS

We compared four annual average air pollution exposure assessment methodologies; two rely on residential exposures only, the other two incorporate estimated time activity patterns. The time-activity patterns were based on assumptions about the activity space and make use of available external data sources for the duration of each activity. Mapping of multiple air pollutants (NO₂, NO_X, PM_2.5, PM_2.5absorbance, PM₁₀) at a fine resolution as input to exposure assessment was based on land use regression modelling. First, we assessed the correlations between the exposures from the four exposure methods. Second, we compared estimates of the cross-sectional associations between air pollution exposures and lung function at age 8 within the PIAMA birth cohort study for the four exposure assessment methodologies.

RESULTS

The exposures derived from the four exposure assessment methodologies were highly correlated (R > 0.95) for all air pollutants. Similar statistically significant decreases in lung function were found for all four methods. For example, for NO₂ the decrease in FEV₁ was -1.40% (CI; -2.54, -0.24%) per IQR (9.14 μg/m³) for front door exposure, and -1.50% (CI; -2.68, -0.30%) for the methodology which incorporates time activity pattern and actual school addresses.

CONCLUSIONS

Exposure estimates from methods based on the residential location only and methods including time activity patterns were highly correlated and associated with similar decreases in lung function. Our study illustrates that the annual average exposure to air pollution for 8-year-old children in the Netherlands is sufficiently captured by residential exposures.

Development of season-dependent land use regression models to estimate BC and PM1 exposure

Reliable estimation of exposure to black carbon (BC) and sub-micrometer particles (PM₁) within a city is challenging because of limited monitoring data as well as the lack of models suitable for assessing the intra-urban environment. In this study, to estimate exposure levels in the inner-city area, we developed land use regression (LUR) models for BC and PM₁ based on specially designed mobile monitoring surveys conducted in 2019 and 2020 for three seasons. The daytime and nighttime LUR models were developed separately to capture additional details on the variation in pollutants. The results of mobile monitoring indicated similar temporal variation characteristics of BC and PM₁. The mean concentrations of pollutants were higher in winter (BC: 4.72 μg/m³; PM₁: 56.97 μg/m³) than in fall (BC: 3.74 μg/m³; PM₁: 33.29 μg/m³) and summer (BC: 2.77 μg/m³; PM₁: 27.04 μg/m³). For both BC and PM₁, higher nighttime concentrations were found in winter and fall, whereas higher daytime concentrations were observed in the summer. A supervised forward stepwise regression method was used to select the predictors for the LUR models. The adjusted R² of the LUR models for BC and PM₁ ranged from 0.39 to 0.66 and 0.45 to 0.80, respectively. Traffic-related predictors were incorporated into all the models for BC. In contrast, more meteorology-related predictors were incorporated into the PM₁ models. The concentration surface based on the LUR models was mapped at a spatial resolution of 100 m, and significant seasonal and diurnal trends were observed. PM₁ was dominated by seasonal variations, whereas BC showed more spatial variation. In conclusion, the development of season-dependent diurnal LUR models based on mobile monitoring could provide a methodology for the estimation of exposure and screening of influencing factors of BC and PM₁ in typical inner-city environments, and support pollution management.

Multiple environmental exposures along daily mobility paths and depressive symptoms: A smartphone-based tracking study

Few studies go beyond the residential environment in assessments of the environment-mental health association, despite multiple environments being encountered in daily life. This study investigated 1) the associations between multiple environmental exposures and depressive symptoms, both in the residential environment and along the daily mobility path, 2) examined differences in the strength of associations between residential- and mobility-based models, and 3) explored sex as a moderator. Depressive symptoms of 393 randomly sampled adults aged 18-65 were assessed using the Patient Health Questionnaire (PHQ-9). Respondents were tracked via global positioning systems- (GPS) enabled smartphones for up to 7 days. Exposure to green space (normalized difference vegetation index (NDVI)), blue space, noise (Lden) and air pollution (particulate matter (PM_2.5)) within 50 m and 100 m of each residential address and GPS point was computed. Multiple linear regression analyses were conducted separately for the residential- and mobility-based exposures. Wald tests were used to assess if the coefficients differed across models. Interaction terms were entered in fully adjusted models to determine if associations varied by sex. A significant negative relationship between green space and depressive symptoms was found in the fully adjusted residential- and mobility-based models using the 50 m buffer. No significant differences were observed in coefficients across models. None of the interaction terms were significant. Our results suggest that exposure to green space in the immediate environment, both at home and along the daily mobility path, is associated with a reduction in depressive symptoms. Further research is required to establish the utility of dynamic approaches to exposure assessment in studies on the environment and mental health.

Prenatal Particulate Matter Exposure Is Associated with Saliva DNA Methylation at Age 15: Applying Cumulative DNA Methylation Scores as an Exposure Biomarker

Exposure in utero to particulate matter (PM2.5 and PM10) is associated with maladaptive health outcomes. Although exposure to prenatal PM2.5 and PM10 has cord blood DNA methylation signatures at birth, signature persistence into childhood and saliva cross-tissue applicability has not been tested. In the Fragile Families and Child Wellbeing Study, a United States 20-city birth cohort, average residential PM2.5 and PM10 during the three months prior to birth was estimated using air quality monitors with inverse distance weighting. Saliva DNA methylation at ages 9 (n = 749) and 15 (n = 793) was measured using the Illumina HumanMethylation 450 k BeadArray. Cumulative DNA methylation scores for particulate matter were estimated by weighting participant DNA methylation at each site by independent meta-analysis effect estimates and standardizing the sums. Using a mixed-effects regression analysis, we tested the associations between cumulative DNA methylation scores at ages 9 and 15 and PM exposure during pregnancy, adjusted for child sex, age, race/ethnicity, maternal income-to-needs ratio, nonmartial birth status, and saliva cell-type proportions. Our study sample was 50.5% male, 56.3% non-Hispanic Black, and 19.8% Hispanic, with a median income-to-needs ratio of 1.4. Mean exposure levels for PM2.5 were 27.9 μg/m³/day (standard deviation: 7.0; 23.7% of observations exceeded safety standards) and for PM10 were 15.0 μg/m³/day (standard deviation: 3.1). An interquartile range increase in PM2.5 exposure (10.73 μg/m³/day) was associated with a −0.0287 standard deviation lower cumulative DNA methylation score for PM2.5 (95% CI: −0.0732, 0.0158, p = 0.20) across all participants. An interquartile range increase in PM10 exposure (3.20 μg/m³/day) was associated with a −0.1472 standard deviation lower cumulative DNA methylation score for PM10 (95% CI: −0.3038, 0.0095, p = 0.06) across all participants. The PM10 findings were driven by the age 15 subset where an interquartile range increase in PM10 exposure was associated with a −0.024 standard deviation lower cumulative DNA methylation score for PM10 (95% CI: −0.043, −0.005, p = 0.012). Findings were robust to adjustment for PM exposure at ages 1 and 3. In utero PM10-associated DNA methylation differences were identified at age 15 in saliva. Benchmarking the timing and cell-type generalizability is critical for epigenetic exposure biomarker assessment.

Beyond air pollution at home: Assessment of personal exposure to PM2.5 using activity-based travel demand model and low-cost air sensor network data

Assessing personal exposure to air pollution is challenging due to the limited availability of human movement data and the complexity of modeling air pollution at high spatiotemporal resolution. Most health studies rely on residential estimates of outdoor air pollution instead which introduces exposure measurement error. Personal exposure for 100,784 individuals in Los Angeles County was estimated by integrating human movement data simulated from the Southern California Association of Governments (SCAG) activity-based travel demand model with hourly PM_2.5 predictions from my 500 m gridded model incorporating low-cost sensor monitoring data. Individual exposures were assigned considering PM_2.5 levels at homes, workplaces, and other activity locations. These dynamic exposures were compared to the residence-based exposures, which do not consider human movement, to examine the degree of exposure estimation bias. The results suggest that exposures were underestimated by 13% (range 5-22%) on average when human movement was not considered, and much of the error was eliminated by accounting for work location. Exposure estimation bias increased for people who exhibited higher mobility levels, especially for workers with long commute distances. Overall, the personal exposures of workers were underestimated by 22% (5-61%) relative to their residence-based exposures. For workers who commute >20 miles, their exposure levels can be at most underestimated by 61%. Omitting mobility resulted in underestimating exposures for people who reside in areas with cleaner air but work in more polluted areas. Similarly, exposures were overestimated for people living in areas with poorer air quality and working in cleaner areas. These could lead to differential estimation biases across racial, ethnic and socioeconomic lines that typically correlate with where people live and work and lead to important exposure and health disparities. This study demonstrates that ignoring human movement and spatiotemporal variability of air pollution could lead to differential exposure misclassification potentially biasing health risk assessments. These improved dynamic approaches can help planners and policymakers identify disadvantaged populations for which exposures are typically misrepresented and might lead to targeted policy and planning implications.

Quantifying the short-term effects of air pollution on health in the presence of exposure measurement error: a simulation study of multi-pollutant model results

BACKGROUND

Most epidemiological studies estimate associations without considering exposure measurement error. While some studies have estimated the impact of error in single-exposure models we aimed to quantify the effect of measurement error in multi-exposure models, specifically in time-series analysis of PM_2.5, NO₂, and mortality using simulations, under various plausible scenarios for exposure errors. Measurement error in multi-exposure models can lead to effect transfer where the effect estimate is overestimated for the pollutant estimated with more error to the one estimated with less error. This complicates interpretation of the independent effects of different pollutants and thus the relative importance of reducing their concentrations in air pollution policy.

METHODS

Measurement error was defined as the difference between ambient concentrations and personal exposure from outdoor sources. Simulation inputs for error magnitude and variability were informed by the literature. Error-free exposures with their consequent health outcome and error-prone exposures of various error types (classical/Berkson) were generated. Bias was quantified as the relative difference in effect estimates of the error-free and error-prone exposures.

RESULTS

Mortality effect estimates were generally underestimated with greater bias observed when low ratios of the true exposure variance over the error variance were assumed (27.4% underestimation for NO₂). Higher ratios resulted in smaller, but still substantial bias (up to 19% for both pollutants). Effect transfer was observed indicating that less precise measurements for one pollutant (NO₂) yield more bias, while the co-pollutant (PM_2.5) associations were found closer to the true. Interestingly, the sum of single-pollutant model effect estimates was found closer to the summed true associations than those from multi-pollutant models, due to cancelling out of confounding and measurement error bias.

CONCLUSIONS

Our simulation study indicated an underestimation of true independent health effects of multiple exposures due to measurement error. Using error parameter information in future epidemiological studies should provide more accurate concentration-response functions.

Underestimated or overestimated? Dynamic assessment of hourly PM2.5 exposure in the metropolitan area based on heatmap and micro-air monitoring stations

Spatio-temporal distributions of air pollution and population are two important factors influencing the patterns of mortality and diseases. Past studies have quantified the adverse effects of long-term exposure to air pollution. However, the dynamic changes of air pollution levels and population mobility within a day are rarely taken into consideration, especially in metropolitan areas. In this study, we use the high-resolution PM_2.5 data from the micro-air monitoring stations, and hourly population mobility simulated by the heatmap based on Location Based Service (LBS) big data to evaluate the hourly active PM_2.5 exposure in a typical Chinese metropolis. The dynamic "active population exposure" is compared spatiotemporally with the static "census population exposure" based on census data. The results show that over 12 h on both study periods, 45.83% of suburbs' population-weighted exposure (PWE) is underestimated, while 100% of rural PWE and more than 34.78% of downtown's PWE are overestimated, with the relative difference reaching from -11 μg/m³ to 7 μg/m³. More notably, the total PWE of the active population at morning peak hours on weekdays is worse than previously realized, about 12.41% of people are exposed to PM_2.5 over 60 μg/m³, about twice as much as that in census scenario. The commuters who live in the suburbs and work in downtown may suffer more from PM_2.5 exposure and uneven environmental resource distribution. This study proposes a new approach of calculating population exposure which can also be extended to quantify other environmental issues and related health burdens.

Environmental exposure during travel: A research review and suggestions forward

Daily travel through the urban fabric exposes urban dwellers to a range of environmental conditions that may have an impact on their health and wellbeing. Knowledge about exposures during travel, their associations with travel behavior, and their social and health outcomes are still limited. In our review, we aim to explain how the current environmental exposure research addresses the interactions between human and environmental systems during travel through their spatial, temporal and contextual dimensions. Based on the 104 selected studies, we identify significant recent advances in addressing the spatiotemporal dynamics of exposure during travel. However, the conceptual and methodological framework for understanding the role of multiple environmental exposures in travel environments is still in an early phase, and the health and wellbeing impacts at individual or population level are not well known. Further research with greater geographical balance is needed to fill the gaps in the empirical evidence, and linking environmental exposures during travel with the causal health and wellbeing outcomes. These advancements can enable evidence-based urban and transport planning to take the next step in advancing urban livability.

Do Individuals' Activity Structures Influence Their PM2.5 Exposure Levels? Evidence from Human Trajectory Data in Wuhan City

Severe air pollution has become a major risk to human health from a global environmental perspective. It has been recognized that human mobility is an essential component in individual exposure assessment. Activity structure reflects the characteristics of human mobility. Thus, a better understanding of the relationship between human activity structure and individual exposure level is of crucial relevance. This study examines this relationship using a large cell-phone GPS dataset in Wuhan, China. The results indicate that there is a strong linear relationship between people’s activity structures and exposures to PM_2.5. Inter-group comparisons based on the four activity structure groups obtained with K-means clustering found that groups with different activity structures do experience different levels of PM_2.5 exposure. Furthermore, differences in detailed characteristics of activity structure were also found at different exposure levels at the intra-group level. These results show that people’s activity structures do influence their exposure levels. The paper provides a new perspective for understanding individual exposure through human activity structure, which helps move the perspective of research on individual exposure from the semantic of physical location to the semantic of human activity pattern.

Exposure to air pollutants and risk of congenital anomalies: A systematic review and metaanalysis

BACKGROUND

Congenital malformations are considered as one of the significant causes of preterm as well as neonatal morbidity and mortality. Literature suggests the association of diverse congenital deformities with maternal exposure to air pollutants. However, the evidence is still inconclusive on the manifestation of these during pregnancy. Thus, systematic review was done on the available epidemiological studies studying the effect of air pollutants on congenital malformations. Furthermore, the meta-analysis was conducted for several combinations of air pollutants and congenital defects.

METHODS

Twenty six epidemiological studies were extracted from the databases and examined for association of risk of congenital defects with air pollutant concentrations. Metaanalysis was done if the risk estimates of the same anomaly and pollutant group were reported in at least three studies.

RESULTS

Each study reported a statistically significant increased risk of congenital malformation with some air pollutant, amid the several tested combinations. Our meta-analysis reported that nitrogen dioxide and PM_2.5 were associated with the risk of pulmonary valve stenosis with OR = 1.74 and OR = 1.42 respectively. The risk of developing tetralogy of Fallot (TOF) was observed to be associated with PM_2.5 with OR = 1.52_. SO₂ exposure was related to a high risk of the ventricular septal defect (VSD) with OR = 1.15 and orofacial defects (OR = 1.27).

CONCLUSION

It is evidenced that ambient air pollutants have some effect on congenital malformations. Standard case definitions, improved methods of exposure, and better control of confounders will improve future research in this area.

Assessment of sociodemographic disparities in environmental exposure might be erroneous due to neighborhood effect averaging: Implications for environmental inequality research

The neighborhood effect averaging problem (NEAP) is a major methodological problem that might affect the accuracy of assessments of individual exposure to mobility-dependent environmental factors (e.g., air/noise pollution, green/blue spaces, or healthy food environments). Focusing on outdoor ground-level ozone as a major air pollutant, this paper examines the NEAP in the evaluation of sociodemographic disparities in people's air pollution exposures in Los Angeles using one-day activity-travel diary data of 3790 individuals. It addresses two questions: (1) How does the NEAP affect the evaluation of sociodemographic disparities in people's air pollution exposures? (2) Which social groups with high residence-based exposures do not experience neighborhood effect averaging? The results of our spatial regression models indicate that assessments of sociodemographic disparities in people's outdoor ground-level ozone exposures might be erroneous when people's daily mobility is ignored because of the different manifestations of neighborhood effect averaging for different social/racial groups. The results of our spatial autologistic regression model reveal that non-workers (e.g., the unemployed, homemakers, the retired, and students) do not experience downward averaging: they have significantly lower odds of experiencing downward averaging that could have attenuated their high exposures experienced in their residential neighborhoods while traveling to other neighborhoods (thus, being doubly disadvantaged). Therefore, to avoid erroneous conclusions in environmental inequality research and ineffective public policies, it would be critical to take the NEAP into account in future studies of sociodemographic disparities related to mobility-dependent environmental factors.

The Impact of Individual Mobility on Long-Term Exposure to Ambient PM2.5: Assessing Effect Modification by Travel Patterns and Spatial Variability of PM2.5

The impact of individuals' mobility on the degree of error in estimates of exposure to ambient PM2.5 concentrations is increasingly reported in the literature. However, the degree to which accounting for mobility reduces error likely varies as a function of two related factors-individuals' routine travel patterns and the local variations of air pollution fields. We investigated whether individuals' routine travel patterns moderate the impact of mobility on individual long-term exposure assessment. Here, we have used real-world time-activity data collected from 2013 participants in Erie/Niagara counties, New York, USA, matched with daily PM2.5 predictions obtained from two spatial exposure models. We further examined the role of the spatiotemporal representation of ambient PM2.5 as a second moderator in the relationship between an individual's mobility and the exposure measurement error using a random effect model. We found that the effect of mobility on the long-term exposure estimates was significant, but that this effect was modified by individuals' routine travel patterns. Further, this effect modification was pronounced when the local variations of ambient PM2.5 concentrations were captured from multiple sources of air pollution data ('a multi-sourced exposure model'). In contrast, the mobility effect and its modification were not detected when ambient PM2.5 concentration was estimated solely from sparse monitoring data ('a single-sourced exposure model'). This study showed that there was a significant association between individuals' mobility and the long-term exposure measurement error. However, the effect could be modified by individuals' routine travel patterns and the error-prone representation of spatiotemporal variability of PM2.5.

Systematic review and meta-analysis of cohort studies of long term outdoor nitrogen dioxide exposure and mortality

Objective

To determine whether long term exposure to outdoor nitrogen dioxide (NO₂) is associated with all-cause or cause-specific mortality.

Methods

MEDLINE, Embase, CENTRAL, Global Health and Toxline databases were searched using terms developed by a librarian. Screening, data extraction and risk of bias assessment were completed independently by two reviewers. Conflicts were resolved through consensus and/or involvement of a third reviewer. Pooling of results across studies was conducted using random effects models, heterogeneity among included studies was assessed using Cochran’s Q and I² measures, and sources of heterogeneity were evaluated using meta-regression. Sensitivity of pooled estimates to individual studies was examined and publication bias was evaluated using Funnel plots, Begg’s and Egger’s tests, and trim and fill.

Results

Seventy-nine studies based on 47 cohorts, plus one set of pooled analyses of multiple European cohorts, met inclusion criteria. There was a consistently high degree of heterogeneity. After excluding studies with probably high or high risk of bias in the confounding domain (n = 12), pooled hazard ratios (HR) indicated that long term exposure to NO₂ was significantly associated with mortality from all/ natural causes (pooled HR 1.047, 95% confidence interval (CI), 1.023–1.072 per 10 ppb), cardiovascular disease (pooled HR 1.058, 95%CI 1.026–1.091), lung cancer (pooled HR 1.083, 95%CI 1.041–1.126), respiratory disease (pooled HR 1.062, 95%CI1.035–1.089), and ischemic heart disease (pooled HR 1.111, 95%CI 1.079–1.144). Pooled estimates based on multi-pollutant models were consistently smaller than those from single pollutant models and mostly non-significant.

Conclusions

For all causes of death other than cerebrovascular disease, the overall quality of the evidence is moderate, and the strength of evidence is limited, while for cerebrovascular disease, overall quality is low and strength of evidence is inadequate. Important uncertainties remain, including potential confounding by co-pollutants or other concomitant exposures, and limited supporting mechanistic evidence. (PROSPERO registration number CRD42018084497)

The MEDEA childhood asthma study design for mitigation of desert dust health effects: implementation of novel methods for assessment of air pollution exposure and lessons learned

BACKGROUND

Desert dust events in Mediterranean countries, originating mostly from the Sahara and Arabian deserts, have been linked to climate change and are associated with significant increase in mortality and hospital admissions from respiratory causes. The MEDEA clinical intervention study in children with asthma is funded by EU LIFE+ program to evaluate the efficacy of recommendations aiming to reduce exposure to desert dust and related health effects.

METHODS

This paper describes the design, methods, and challenges of the MEDEA childhood asthma study, which is performed in two highly exposed regions of the Eastern Mediterranean: Cyprus and Greece-Crete. Eligible children are recruited using screening surveys performed at primary schools and are randomized to three parallel intervention groups: a) no intervention for desert dust events, b) interventions for outdoor exposure reduction, and c) interventions for both outdoor and indoor exposure reduction. At baseline visits, participants are enrolled on MEDena® Health-Hub, which communicates, alerts and provides exposure reduction recommendations in anticipation of desert dust events. MEDEA employs novel environmental epidemiology and telemedicine methods including wearable GPS, actigraphy, health parameters sensors as well as indoor and outdoor air pollution samplers to assess study participants' compliance to recommendations, air pollutant exposures in homes and schools, and disease related clinical outcomes.

DISCUSSION

The MEDEA study evaluates, for the first time, interventions aiming to reduce desert dust exposure and implement novel telemedicine methods in assessing clinical outcomes and personal compliance to recommendations. In Cyprus and Crete, during the first study period (February-May 2019), a total of 91 children participated in the trial while for the second study period (February-May 2020), another 120 children completed data collection. Recruitment for the third study period (February-May 2021) is underway. In this paper, we also present the unique challenges faced during the implementation of novel methodologies to reduce air pollution exposure in children. Engagement of families of asthmatic children, schools and local communities, is critical. Successful study completion will provide the knowledge for informed decision-making both at national and international level for mitigating the health effects of desert dust events in South-Eastern Europe.

TRIAL REGISTRATION

ClinicalTrials.gov: NCT03503812 , April 20, 2018.

Assessing personal exposure using Agent Based Modelling informed by sensors technology

Technology innovations create possibilities to capture exposure-related data at a great depth and breadth. Considering, though, the substantial hurdles involved in collecting individual data for whole populations, this study introduces a first approach of simulating human movement and interaction behaviour, using Agent Based Modelling (ABM). A city scale ABM was developed for urban Thessaloniki, Greece that feeds into population-based exposure assessment without imposing prior bias, basing its estimations onto emerging properties of the behaviour of the computerised autonomous decision makers (agents) that compose the city-system. Population statistics, road and buildings networks data were transformed into human, road and building agents, respectively. Survey outputs with time-use patterns were associated with human agent rules, aiming to model representative to real-world behaviours. Moreover, time-geography of exposure data, derived from a local sensors campaign, was used to inform and enhance the model. As a prevalence of an agent-specific decision-making, virtual individuals of different sociodemographic backgrounds express different spatiotemporal behaviours and their trajectories are coupled with spatially resolved pollution levels. Personal exposure was evaluated by assigning PM concentrations to human agents based on coordinates, type of location and intensity of encountered activities. Study results indicated that PM2.5 inhalation adjusted exposure between housemates can differ by 56.5% whereas exposure between two neighbours can vary by as much as 87%, due to the prevalence of different behaviours. This study provides details of a new methodology that permits the cost-effective construction of refined time-activity diaries and daily exposure profiles, taking into account different microenvironments and sociodemographic characteristics. The proposed method leads to a refined exposure assessment model, addressing effectively vulnerable subgroups of population. It can be used for evaluating the probable impacts of different public health policies prior to implementation reducing, therefore, the time and expense required to identify efficient measures.

Coupling mobile phone data with machine learning: How misclassification errors in ambient PM2.5 exposure estimates are produced?

BACKGROUND

Most studies relying on time-activity diary or traditional air pollution modelling approach are insufficient to suggest the impacts of ignoring individual mobility and air pollution variations on misclassification errors in exposure estimates. Moreover, very few studies have examined whether such impacts differ across socioeconomic groups.

OBJECTIVES

We aim to examine how ignoring individual mobility and PM2.5 variations produces misclassification errors in ambient PM2.5 exposure estimates.

METHODS

We developed a geo-informed backward propagation neural network model to estimate hourly PM2.5 concentrations in terms of remote sensing and geospatial big data. Combining the estimated PM2.5 concentrations and individual trajectories derived from 755,468 mobile phone users on a weekday in Shenzhen, China, we estimated four types of individual total PM2.5 exposures during weekdays at multi-temporal scales. The estimate ignoring individual mobility, PM2.5 variations or both was compared with the hypothetical error-free estimate using paired sample t-test. We then quantified the exposure misclassification error using Pearson correlation analysis. Moreover, we examined whether the misclassification error differs across different socioeconomic groups. Taking findings of ignoring individual mobility as an example, we further investigated whether such findings are robust to the different selections of time.

RESULTS

We found that the estimate ignoring PM2.5 variations, individual mobility or both was statistically different from the hypothetical error-free estimate. Ignoring both factors produced the largest exposure misclassification error. The misclassification error was larger in the estimate ignoring PM2.5 variations than that ignoring individual mobility. People with high economic status suffered from a larger exposure misclassification error. The findings were robust to the different selections of time.

CONCLUSIONS

Ignoring individual mobility, PM2.5 variations or both leads to misclassification errors in ambient PM2.5 exposure estimates. A larger misclassification error occurs in the estimate neglecting PM2.5 variations than that ignoring individual mobility, which is seldom reported before.

Quantifying the impact of daily mobility on errors in air pollution exposure estimation using mobile phone location data

One major source of uncertainty in accurately estimating human exposure to air pollution is that human subjects move spatiotemporally, and such mobility is usually not considered in exposure estimation. How such mobility impacts exposure estimates at the population and individual level, particularly for subjects with different levels of mobility, remains under-investigated. In addition, a wide range of methods have been used in the past to develop air pollutant concentration fields for related health studies. How the choices of methods impact results of exposure estimation, especially when detailed mobility information is considered, is still largely unknown. In this study, by using a publicly available large cell phone location dataset containing over 35 million location records collected from 310,989 subjects, we investigated the impact of individual subjects' mobility on their estimated exposures for five chosen ambient pollutants (CO, NO₂, SO₂, O₃ and PM_2.5). We also estimated exposures separately for 10 groups of subjects with different levels of mobility to explore how increased mobility impacted their exposure estimates. Further, we applied and compared two methods to develop concentration fields for exposure estimation, including one based on Community Multiscale Air Quality (CMAQ) model outputs, and the other based on the interpolated observed pollutant concentrations using the inverse distance weighting (IDW) method. Our results suggest that detailed mobility information does not have a significant influence on mean population exposure estimate in our sample population, although impacts can be substantial at the individual level. Additionally, exposure classification error due to the use of home-location data increased for subjects that exhibited higher levels of mobility. Omitting mobility could result in underestimation of exposures to traffic-related pollutants particularly during afternoon rush-hour, and overestimate exposures to ozone especially during mid-afternoon. Between CMAQ and IDW, we found that the IDW method generates smooth concentration fields that were not suitable for exposure estimation with detailed mobility data. Therefore, the method for developing air pollution concentration fields when detailed mobility data were to be applied should be chosen carefully. Our findings have important implications for future air pollution health studies.

Maternal air pollution exposure and congenital heart defects in offspring: A systematic review and meta-analysis

BACKGROUND

Congenital heart defects (CHDs) has a multifactorial causation with a strong genetic component and many environmental triggers. Emerging body of empirical studies suggest that air pollution is an important contributor to the development of CHDs, however, there still remains some controversy over the current evidence, and to the authors' knowledge, no studies have reviewed the most recent evidence.

OBJECTIVES

We performed a systematic review and meta-analysis of epidemiological literature to investigate the relationship between maternal air pollution exposure and CHDs risk in offspring. The presence of heterogeneity and publication bias across available studies were also examined.

METHODS

An extensive literature search of epidemiological studies pertaining to air pollution and CHDs, published in English language, until August 1, 2019 was conducted. Summary risk estimates of pollution-outcome combinations were calculated for i) risk per specific increment of concentration and ii) risk at high versus low exposure level in each study using fixed-effect model or random-effects model.

RESULTS

A total of 26 studies were finally included. In the meta-analyses, high versus low carbon monoxide (CO) exposure was associated with an increased risk of tetralogy of Fallot [odds ratio (OR) = 1.21, 95% confidence interval (CI): 1.04-1.41], yet particulate matter ≤ 5 μm (PM_2.5) exposure was marginally associated with it. Increased risk of atrial septal defects (ASDs) was found for each 10 μg/m³ and 10 ppb increment in particulate matter ≤ 10 μm (PM₁₀) and ozone (O₃) exposure, respectively (OR = 1.04, 95% CI: 1.00-1.09; OR = 1.09, 95% CI: 1.02-1.17). Categorical nitrogen dioxide (NO₂) exposure was associated with an increased risk of coarctation of the aorta (OR for high versus low = 1.14, 95% CI: 1.02-1.26). Analyses for other combinations yielded none statistically significant associations. Sensitive analyses showed similar findings.

CONCLUSIONS

The summary effect estimates from this study suggest statistically significant associations between increased risk of specific CHDs subtypes and PM_2.5, PM₁₀, NO₂, CO, and O₃ exposures. Further studies, especially conducted in developing countries, with improvements in exposure assessing, outcome harmonizing, and mechanistic understanding are needed to elaborate the suggestive associations.

Evaluating Spatiotemporal Resolution of Trace Element Concentrations and Pb Isotopic Compositions of Honeybees and Hive Products as Biomonitors for Urban Metal Distribution

Assessing metal distributions in cities is an important aspect of urban environmental quality management. Western honeybees (Apis mellifera) and their products are biomonitors that can elucidate small-scale metal distribution within a city. We compare range and variations in trace element (TE) concentrations and lead (Pb) isotopic compositions of honey, bee tissue, bee pollen, and propolis collected throughout Metro Vancouver (BC, Canada). Honey, bee, and bee pollen results have similar TE and isotopic trends; samples collected in urban and industrialized areas exhibit elevated concentrations of anthropogenically influenced TE (e.g., Pb, Zn, V, and Ti) and a less radiogenic Pb isotopic composition (i.e., lower 206Pb/207Pb and elevated 208Pb/206Pb) relative to their suburban and rural counterparts. For example, 206Pb/207Pb, 208Pb/206Pb in honey range from 1.126, 2.131 and 1.184, 2.063; extremes measured in honey from urban and suburban/rural areas, respectively. Except for propolis, measured and interpolated (kriged) results in all materials reflect the immediate zoning or land use setting near the hive, providing kilometer-scale geospatial resolution, suitable for monitoring urban systems. Statistical analysis reveals that no systematic variations or intra- or inter-annual trends exist in TE concentrations or Pb isotopic compositions, including among sampling and field methods (i.e., old vs. new hive equipment and honey from the brood nest box vs. honey super). The results of this systematic study using honeybees and hive products in Metro Vancouver provide a robust, current baseline for future comparison of local land use and environmental policy change.

Influence of exposure measurement errors on results from epidemiologic studies of different designs

In epidemiologic studies of health effects of air pollution, measurements or models are used to estimate exposure. Exposure estimates have errors that propagate to effect estimates in exposure-response models. We critically evaluate how types of exposure measurement error influenced bias and precision of effect estimates to understand conditions affecting interpretation of exposure-response models for epidemiologic studies of exposure to PM_2.5, NO₂, and SO₂. We reviewed available literature on exposure measurement error for time-series and long-term exposure epidemiology studies. For time-series studies, time-activity error (daily exposure concentration did not account for variation in exposure due to time-activity during a day) and nonambient (indoor) sources negatively biased the effect estimates and increased standard error, so uncertainty grew with increasing bias while underestimating the true health effect in these studies. Spatial error (deviation between true exposure concentration at an individual's location and concentration at a receptor) was ascribed to negatively biased effect estimates in most cases. Positive bias occurred for spatially variable pollutants when the variance of error correlated with the exposure estimate. For long-term exposure studies, most spatial errors did not bias the effect estimate. For both time-series and long-term exposure studies reviewed, large uncertainties were observed when exposure concentration was modeled with low spatial and temporal resolution for a spatially variable pollutant.

Influence of travel behaviour and daily mobility on exposure to traffic-related air pollution

This study evaluates the daily exposure of urban residents across various commuting modes and destinations by intersecting data from a travel survey with exposure surfaces for ultrafine particles and black carbon, in Toronto, Canada. We demonstrate that exposure misclassification is bound to arise when we approximate daily exposure with the concentration at the home location. We also identify potential inequities in the distribution of exposure to traffic-related air pollution whereby those who are mostly responsible for the generation of traffic-related air pollution (drivers and passengers) are exposed the least while active commuters and transit riders, are exposed the most.

Assessment of residential exposures to agricultural pesticides: A scoping review

The assessment of residential exposure to agricultural pesticides is a major issue for public health, regulatory and management purposes. In recent years, research into this field has developed considerably. The purpose of this scoping review is to provide an overview of scientific literature characterizing residential exposure to agricultural pesticides and to identify potential gaps in this research area. This work was conducted according to the JBI and PRISMA guidelines. Three databases were consulted. At least two experts selected the eligible studies. Our scoping review enabled us to identify 151 articles published between 1988 and 2019 dealing with the assessment of residential exposure to agricultural pesticides. Of these, 98 (64.9%) were epidemiological studies investigating possible links between pesticide exposure and the onset of adverse health effects, principally cancers and reproductive outcomes. They predominantly used Geographic Information Systems and sometimes surveys or interviews to calculate surrogate exposure metrics, the most common being the amounts of pesticides applied or the surface area of crops around the dwelling. Twenty-six (17.2%) were observational measurement studies conducted to quantify levels of pesticide exposure and identify their possible determinants. These studies assessed exposure by measuring pesticides in biological and environmental matrices, mostly in urines and house dust. Finally, we found only eight publications (5.3%) that quantified the risk to human health due to residential exposure for management purposes, in which exposure was mainly determined using probabilistic models. Pesticide exposure appears to be largely correlated with the spatial organization of agriculture activities in a territory. The determinants and routes of exposure remain to be explored to improve the conduct of epidemiological and risk assessment studies and to help prevent future exposures. Improvement could be expected from small-scale studies combining different methods of exposure assessment.

Residential green space, air pollution, socioeconomic deprivation and cardiovascular medication sales in Belgium: A nationwide ecological study

Green space may improve cardiovascular (CV) health, for example by promoting physical activity and by reducing air pollution, noise and heat. Socioeconomic and environmental factors may modify the health effects of green space. We examined the association between residential green space and reimbursed CV medication sales in Belgium between 2006 and 2014, adjusting for socioeconomic deprivation and air pollution. We analyzed data for 11,575 census tracts using structural equation models for the entire country and for the administrative regions. Latent variables for green space, air pollution and socioeconomic deprivation were used as predictors of CV medication sales and were estimated from the number of patches of forest, census tract relative forest cover and relative forest cover within a 600 m buffer around the census tract; annual mean concentrations of PM_2.5, BC and NO₂; and percentages of inhabitants that were foreign-born from lower- and mid-income countries, unemployed or had no higher education. A direct association between socioeconomic deprivation and CV medication sales [parameter estimate (95% CI): 0.26 (0.25; 0.28)] and inverse associations between CV medication sales and green space [-0.71 (-0.80; -0.61)] and air pollution [-1.62 (-1.69; -0.61)] were observed. In the regional models, the association between green space and CV medication sales was stronger in the region with relatively low green space cover (Flemish Region, standardized estimate -0.16) than in the region with high green space cover (Walloon Region, -0.10). In the highly urbanized Brussels Capital Region the association tended towards the null. In all regions, the associations between CV medication sales and socioeconomic deprivation were direct and more prominent. Our results suggest that there may be an inverse association between green space and CV medication sales, but socioeconomic deprivation was always the strongest predictor of CV medication sales.

Estimating exposure to fine particulate matter emissions from vehicle traffic: Exposure misclassification and daily activity patterns in a large, sprawling region

Vehicle traffic is responsible for a significant portion of toxic air pollution in urban areas that has been linked to a wide range of adverse health outcomes. Most vehicle air quality analyses used for transportation planning and health effect studies estimate exposure from the measured or modeled concentration of an air pollutant at a person's home. This study evaluates exposure to fine particulate matter from vehicle traffic and the magnitude and cause of exposure misclassification that result from not accounting for population mobility during the day in a large, sprawling region. We develop a dynamic exposure model by integrating activity-based travel demand, vehicle emission, and air dispersion models to evaluate the magnitude, components and spatial patterns of vehicle exposure misclassification in the Atlanta, Georgia metropolitan area. Overall, we find that population exposure estimates increase by 51% when population mobility is accounted for. Errors are much larger in suburban and rural areas where exposure is underestimated while exposure may be overestimated near high volume roadways and in the urban core. Exposure while at work and traveling account for much of the error. We find much larger errors than prior studies, all of which have focused on more compact urban regions. Since many people spend a large part of their day away from their homes and vehicle emissions are known to create "hotspots" along roadways, home-based exposure is unlikely to be a robust estimator of a person's actual exposure. Accounting for population mobility in vehicle emission exposure studies may reveal more effective mitigation strategies, important differences in exposure between population groups with different travel patterns, and reduce exposure misclassification in health studies.

Who Could Not Avoid Exposure to High Levels of Residence-Based Pollution by Daily Mobility? Evidence of Air Pollution Exposure from the Perspective of the Neighborhood Effect Averaging Problem (NEAP)

It has been widely acknowledged that air pollution has a considerable adverse impact on people’s health. Disadvantaged groups such as low-income people are often found to experience greater negative effects of environmental pollution. Thus, improving the accuracy of air pollution exposure assessment might be essential to policy-making. Recently, the neighborhood effect averaging problem (NEAP) has been identified as a specific form of possible bias when assessing individual exposure to air pollution and its health impacts. In this paper, we assessed the real-time air pollution exposure and residential-based exposure of 106 participants in a high-pollution community in Beijing, China. The study found that: (1) there are significant differences between the two assessments; (2) most participants experienced the NEAP and could lower their exposure by their daily mobility; (3) three vulnerable groups with low daily mobility and could not avoid the high pollution in their residential neighborhoods were identified as exceptions to this: low-income people who have low levels of daily mobility and limited travel outside their residential neighborhoods, blue-collar workers who spend long hours at low-end workplaces, and elderly people who face many household constraints. Public policies thus need to focus on the hidden environmental injustice revealed by the NEAP in order to improve the well-being of these environmentally vulnerable groups.

Novel Approaches to Air Pollution Exposure and Clinical Outcomes Assessment in Environmental Health Studies

An accurate assessment of pollutants’ exposure and precise evaluation of the clinical outcomes pose two major challenges to the contemporary environmental health research. The common methods for exposure assessment are based on residential addresses and are prone to many biases. Pollution levels are defined based on monitoring stations that are sparsely distributed and frequently distanced far from residential addresses. In addition, the degree of an association between outdoor and indoor air pollution levels is not fully elucidated, making the exposure assessment all the more inaccurate. Clinical outcomes’ assessment, on the other hand, mostly relies on the access to medical records from hospital admissions and outpatients’ visits in clinics. This method differentiates by health care seeking behavior and is therefore, problematic in evaluation of an onset, duration, and severity of an outcome. In the current paper, we review a number of novel solutions aimed to mitigate the aforementioned biases. First, a hybrid satellite-based modeling approach provides daily continuous spatiotemporal estimations with improved spatial resolution of 1 × 1 km2 and 200 × 200 m2 grid, and thus allows a more accurate exposure assessment. Utilizing low-cost air pollution sensors allowing a direct measurement of indoor air pollution levels can further validate these models. Furthermore, the real temporal-spatial activity can be assessed by GPS tracking devices within the individuals’ smartphones. A widespread use of smart devices can help with obtaining objective measurements of some of the clinical outcomes such as vital signs and glucose levels. Finally, human biomonitoring can be efficiently done at a population level, providing accurate estimates of in-vivo absorbed pollutants and allowing for the evaluation of body responses, by biomarkers examination. We suggest that the adoption of these novel methods will change the research paradigm heavily relying on ecological methodology and support development of the new clinical practices preventing adverse environmental effects on human health.

On the accuracy and potential of Google Maps location history data to characterize individual mobility for air pollution health studies

Appropriately characterizing spatiotemporal individual mobility is important in many research areas, including epidemiological studies focusing on air pollution. However, in many retrospective air pollution health studies, exposure to air pollution is typically estimated at the subjects' residential addresses. Individual mobility is often neglected due to lack of data, and exposure misclassification errors are expected. In this study, we demonstrate the potential of using location history data collected from smartphones by the Google Maps application for characterizing historical individual mobility and exposure. Here, one subject carried a smartphone installed with Google Maps, and a reference GPS data logger which was configured to record location every 10 s, for a period of one week. The retrieved Google Maps Location History (GMLH) data were then compared with the GPS data to evaluate their effectiveness and accuracy of the GMLH data to capture individual mobility. We also conducted an online survey (n = 284) to assess the availability of GMLH data among smartphone users in the US. We found the GMLH data reasonably captured the spatial movement of the subject during the one-week time period at up to 200 m resolution. We were able to accurately estimate the time the subject spent in different microenvironments, as well as the time the subject spent driving during the week. The estimated time-weighted daily exposures to ambient particulate matter using GMLH and the GPS data logger were also similar (error less than 1.2%). Survey results showed that GMLH data may be available for 61% of the survey sample. Considering the popularity of smartphones and the Google Maps application, detailed historical location data are expected to be available for large portion of the population, and results from this study highlight the potential of these location history data to improve exposure estimation for retrospective epidemiological studies.

Dynamic Urban Environmental Exposures on Depression and Suicide (NEEDS) in the Netherlands: a protocol for a cross-sectional smartphone tracking study and a longitudinal population register study

INTRODUCTION

Environmental exposures are intertwined with mental health outcomes. People are exposed to the environments in which they currently live, and to a multitude of environments along their daily movements and through their residential relocations. However, most research assumes that people are immobile, disregarding that such dynamic exposures also serve as stressors or buffers potentially associated with depression and suicide risk. The aim of the Dynamic Urban Environmental Exposures on Depression and Suicide (NEEDS) study is to examine how dynamic environmental exposures along people's daily movements and over their residential histories affect depression and suicide mortality in the Netherlands.

METHODS AND ANALYSIS

The research design comprises two studies emphasising the temporality of exposures. First, a cross-sectional study is assessing how daily exposures correlate with depression. A nationally representative survey was administered to participants recruited through stratified random sampling of the population aged 18-65 years. Survey data were enriched with smartphone-based data (eg, Global Positioning System tracking, Bluetooth sensing, social media usage, communication patterns) and environmental exposures (eg, green and blue spaces, noise, air pollution). Second, a longitudinal population register study is addressing the extent to which past environmental exposures over people's residential history affect suicide risk later in life. Statistical and machine learning-based models are being developed to quantify environment-health relations.

ETHICS AND DISSEMINATION

Ethical approval (FETC17-060) was granted by the Ethics Review Board of Utrecht University, The Netherlands. Project-related findings will be disseminated at conferences and in peer-reviewed journal papers. Other project outcomes will be made available through the project's web page, http://www.needs.sites.uu.nl.

Ecological determinants of respiratory health: Examining associations between asthma emergency department visits, diesel particulate matter, and public parks and open space in Los Angeles, California

Los Angeles County (LAC) low-income communities of color experience uneven asthma rates, evidenced by asthma emergency department visits (AEDV). This has partly been attributed to inequitable exposure to diesel particulate matter (DPM). Promisingly, public parks and open space (PPOS) contribute to DPM mitigation. However, low-income communities of color with limited access to PPOS may be deprived of associated public health benefits. Therefore, this novel study investigates the AEDV, DPM, PPOS nexus to address this public health dilemma and inform public policy in at-risk communities. Optimized Hotspot Analysis was used to examine geographic clustering of AEDVs, DPM, and PPOS at the census tract unit of analysis in LAC. Ordinary Least Squares (OLS) regression analysis was used to examine the extent to which DPM and PPOS predict AEDVs. Finally, Geographic Weighted Regression (GWR) was employed to account for spatial dependence in the global OLS model. Optimized Hotspot Analysis confirmed significant clustering of elevated AEDVs and DPM in census tracts with reduced PPOS. After controlling for pertinent demographic characteristics (poverty, children, race/ethnicity), regression analysis confirmed that DPM was significantly positively associated with AEDVs, whereas PPOS was significantly negatively associated with AEDVs. Furthermore, GWR revealed that 71.5% of LACs census tracts would benefit from DPM reductions and 79.4% would benefit from PPOS increases toward redressing AEDVs. This is the first study to identify AEDV reductions in census tracts with higher concentrations of PPOS. Thus, reducing DPM and increasing PPOS may serve to improve asthma outcomes, particularly in low-income communities of color.