Measurement errors in the assessment of exposure to solar ultraviolet radiation and its impact on risk estimates in epidemiological studies

Residential exposure to solar ultraviolet radiation and risk of childhood hematological malignancies in Switzerland: A census-based cohort study

Still little is known about possible environmental risk factors of childhood hematological malignancies (CHM). Previous studies suggest that ultraviolet radiation (UVR) exposure is associated with a lower risk of acute lymphoblastic leukemia (ALL) in children. We investigated the association between solar UVR exposure and risk of CHM in Switzerland, a country with greatly varying topography and weather conditions. We included all resident children aged 0-15 years from the Swiss National Cohort during 1990-2016 and identified incident cancer cases through probabilistic record linkage with the Swiss Childhood Cancer Registry. We estimated the overall annual mean UV level and the mean level for the month of July during 2004-2018 at children's homes using a climatological model of the midday (11 am-3 pm) UV-index (UVI) with a spatial resolution of 1.5-2 km. Using risk-set sampling, we obtained a nested case-control data set matched by birth year and fitted conditional logistic regression models (virtually equivalent to analyzing full cohort data using proportional hazards models) adjusting for sex, neighborhood socio-economic position, urbanization, air pollution, and background ionizing radiation. Our analyses included 1446 cases of CHM. Estimated adjusted hazard ratios (HR) per unit increase in UVI in July were 0.76 (95% CI 0.59-0.98) for leukemia and 0.74 (0.55-0.98) for ALL. Results for annual exposure were similar but confidence intervals were wider and included one. We found no evidence for an association for lymphoma overall (HR 1.14, 95% CI 0.59-2.19 for annual exposure) or diagnostic subgroups. Our study provides further support for an inverse association between exposure to ambient solar UVR and childhood ALL.

Air pollution and meteorology as risk factors for COVID-19 death in a cohort from Southern California

BACKGROUND

Recent evidence links ambient air pollution to COVID-19 incidence, severity, and death, but few studies have analyzed individual-level mortality data with high quality exposure models.

METHODS

We sought to assess whether higher air pollution exposures led to greater risk of death during or after hospitalization in confirmed COVID-19 cases among patients who were members of the Kaiser Permanente Southern California (KPSC) healthcare system (N=21,415 between 06-01-2020 and 01-31-2022 of whom 99.85 % were unvaccinated during the study period). We used 1 km resolution chemical transport models to estimate ambient concentrations of several common air pollutants, including ozone, nitrogen dioxide, and fine particle matter (PM_2.5). We also derived estimates of pollutant exposures from ultra-fine particulate matter (PM_0.1), PM chemical species, and PM sources. We employed Cox proportional hazards models to assess associations between air pollution exposures and death from COVID-19 among hospitalized patients.

FINDINGS

We found significant associations between COVID-19 death and several air pollution exposures, including: PM_2.5 mass, PM_0.1 mass, PM_2.5 nitrates, PM_2.5 elemental carbon, PM_2.5 on-road diesel, and PM_2.5 on-road gasoline. Based on the interquartile (IQR) exposure increment, effect sizes ranged from hazard ratios (HR) = 1.12 for PM_2.5 mass and PM_2.5 nitrate to HR ∼ 1.06-1.07 for other species or source markers. Humidity and temperature in the month of diagnosis were also significant negative predictors of COVID-19 death and negative modifiers of the air pollution effects.

INTERPRETATION

Air pollution exposures and meteorology were associated the risk of COVID-19 death in a cohort of patients from Southern California. These findings have implications for prevention of death from COVID-19 and for future pandemics.

A Genomic Approach to Identify the Different between Acute and Chronic UVB Exposures in the Causation of Inflammation and Cancer

As a principal component of solar radiation, ultraviolet B (UVB) exposure can be harmful depending on the duration and intensity because the human body can easily be exposed to it. Many studies have demonstrated that UVB causes a series of inflammatory and other skin disorders. UVB has been classified as the Group 1 carcinogen by the International Agency for Research on Cancer. Diverse studies have focused on UVB exposure but the complex perspective of acute and chronic UVB exposure is still lacking. This review presents the differences between acute and chronic exposure to UVB and summarizes public information in terms of toxicogenomic characteristics. We also demonstrated the differences between adverse effects of acute and chronic UVB exposure on the skin system. From the published literatures, we compared the biological pathways predict of the adverse effects caused by each UVB exposure type. Furthermore, our review not only clarifies the differences in each UVB exposure network but also suggests major hub genes related to cellular mechanisms and diseases that are thought to be affected by acute and chronic UVB exposure.

A prospective cohort analysis of residential radon and UV exposures and malignant melanoma mortality in the Swiss population

BACKGROUND

Radon is a radioactive noble gas naturally found in the earth crust that can accumulate in buildings. In addition to lung cancer, alpha particles emitted by radon may contribute to the risk of skin cancer. We evaluated the association between residential radon exposure and skin cancer mortality, over a fifteen year period, taking residential ultra-violet (UV) exposure into account.

METHODS

We included 4.9 million adults from the Swiss National Cohort. Hazard ratios for melanoma mortality were estimated using Cox proportional hazard models (20+ years old; follow-up 2001-2015). Long-term modelled residential radon and ambient UV exposures were assigned at baseline, and included together in the Cox models. With age as a time scale, models were adjusted for calendar time, sex, marital status, education, mother tongue, socioeconomic position, and occupational environment with potential for UV exposure. Age specific hazard ratios were derived. Effect modification, sensitivity analyses and the shape of the exposure response, as well as secondary analysis using other outcome definitions, were investigated.

RESULTS

During follow-up (average of 13.6 years), 3,979 melanoma deaths were observed. Associations declined with age, with an adjusted hazard ratio per 100 Bq/m³ radon at age 60 of 1.10 (95% CI: 0.99, 1.23). The dose-response showed an approximate linear trend between the minimum and mean radon exposure of 75 Bq/m³. Having outdoor occupation significantly increased the risk of melanoma mortality associated with UV exposure compared to indoor jobs. Analysis restricted to the last five years of follow-up showed similar results compared to the main analysis. Similar associations were found for mortality from melanoma and non-melanoma skin cancer combined.

CONCLUSION

With double the follow-up time, this study confirmed the previously observed association between residential radon exposure and melanoma and non-melanoma skin cancer mortality in Switzerland. Accumulation of radon indoors is preventable and of public health importance.

Ultraviolet radiation and age at natural menopause in a nationwide, prospective US cohort

BACKGROUND

Solar ultraviolet radiation (UV) is a critical environmental factor for dermal conversion of vitamin D, which is suggested to support reproductive health. However, current epidemiological studies have reported conflicting results on the associations between vitamin D levels and ovarian reserve. Further, few studies have considered UV exposure and reproductive aging, which is closely related to declined ovarian reserve.

OBJECTIVES

We sought to examine the associations of long-term UV exposure and age at natural menopause in a large, nationwide, prospective cohort.

METHODS

Participants in the Nurses' Health Study II (NHS II) who were premenopausal at age 40 were included and followed through 2015. Erythemal UV radiation from a high-resolution geospatial model was linked to the participants' residential histories. Early-life UV was estimated using the reported state of residence at birth, age 15, and age 30. We used time-varying Cox proportional hazards models to estimate the hazard ratio (HR) and 95% confidence intervals (CIs) for natural menopause, adjusting for potential confounders and predictors of menopause.

RESULTS

A total of 63,801 women reported natural menopause across the 1,051,185 person-years of follow-up among 105,631 eligible participants. We found very modest associations with delayed menopause for long-term UV exposure (adjusted HR comparing highest to lowest quartile of cumulative average UV: 0.96, 95% CI: 0.94, 0.99). There was a suggestive inverse association between UV at age 30 with menopause (adjusted HR comparing highest to lowest quartile: 0.97, 95% CI: 0.95, 1.00) but not with UV at birth and age 15.

CONCLUSIONS

Solar UV exposure in adulthood was modestly associated with later onset of menopause. Although consistent with previous findings on vitamin D intake and menopause in the same population, these weak associations found in this study may not be of clinical relevance.

Estimating personal solar ultraviolet radiation exposure through time spent outdoors, ambient levels and modelling approaches

BACKGROUND

 Evidence on validation of surrogates applied to evaluate the personal exposure levels of solar ultraviolet radiation (UVR) in epidemiological studies is scarce.

OBJECTIVES

 To determine and compare the validity of three approaches, including (i) ambient UVR levels, (ii) time spent outdoors, and (iii) a modelling approach integrating the aforementioned parameters, to estimate personal UVR exposure over a period of six months among indoor and outdoor workers and in different seasons (summer/winter).

METHODS

 This validation study was part of the EU ICEPURE project and was performed between July 2010 and January 2011 in a convenience sample of indoor and outdoor workers in Catalunya - Spain. We developed linear regression models to quantify the variation in the objectively measured personal UVR exposure that could be explained, separately, by the ambient UVR, time spent outdoors, and modelled UVR levels.

RESULTS

Our 39 participants - mostly male and with a median age of 35 years- presented a median daily objectively measured UVR of 0.37 standard erythemal doses (SEDs). The UVR dose was statistically significantly higher in summer and for outdoor workers. The modelled personal UVR exposure and self-reported time spent outdoors could reasonably predict the variation in the objectively measured personal UVR levels (R² = (0.75, 0.79)), whereas ambient UVR was a poor predictor (R² =0.21). No notable differences were found between seasons or occupation.

CONCLUSIONS

 Time outdoors and our modelling approach were reliable predictors and of value to be applied in epidemiological studies of the health effects of current exposure to UVR.

Ultraviolet radiation as a predictor of sex hormone levels in postmenopausal women: A European multi-center study (ECRHS)

BACKGROUND

Solar ultraviolet radiation (UVR) affects the body through pathways that exhibit positive as well as negative health effects such as immunoregulation and vitamin D production. Different vitamin D metabolites are associated with higher or lower concentrations of estrogens and may thus alter the female sex hormone balance.

OBJECTIVE

To study whether exposure to UVR, as a modifiable lifestyle factor, is associated with levels of sex hormones (17β-estradiol, estrone, estrone 3-sulfate, testosterone, dehydroepiandrosterone sulfate), gonadotropins (follicle stimulating hormone, luteinizing hormone) as well as sex hormone binding globulin in postmenopausal women, and thus investigate whether managing UVR exposure can influence the hormone balance, with potential benefits for the biological aging process.

METHODS

The study included 580 postmenopausal women from six European countries, participating in the European Community Respiratory Health Survey (2010-2014). Average UVR exposure during the month before blood sampling was estimated based on personal sun behavior and ambient levels. Hormone concentrations were measured in serum using state-of-the-art methods. Subsequently we applied linear mixed-effects models, including center as random intercept, hormone concentrations (one at a time) as outcome and UVR, age, skin type, body mass index, vitamin D from dietary sources, smoking, age at completed full-time education and season of blood sampling as fixed-effect predictors.

RESULTS

One interquartile range increase in UVR exposure was associated with decreased levels of 17β-estradiol (-15.6 pmol/L, 95 % Confidence Interval (CI): -27.69, -3.51) and estrone (-13.36 pmol/L, 95 % CI: -26.04, -0.68) and increased levels of follicle stimulating hormone (9.34IU/L, 95 % CI: 2.91, 15.77) and luteinizing hormone (13.86 IU/daL, 95 % CI: 2.48, 25.25).

CONCLUSIONS

Exposure to UVR is associated with decreased estrogens and increased gonadotropins in postmenopausal women, a status associated with osteoporosis, lung function decline and other adverse health effects. This study indicates that managing UVR exposure has potential to influence the hormone balance and counteract adverse health conditions after menopause.

Solar Ultraviolet Radiation and Vitamin D Deficiency on Epstein-Barr Virus Reactivation: Observational and Genetic Evidence From a Nasopharyngeal Carcinoma-Endemic Population

Background

We investigated the relationship of Epstein-Barr virus viral capsid antigen (EBV VCA-IgA) serostatus with ambient and personal ultraviolet radiation (UVR) and vitamin D exposure.

Methods

Using data from a multicenter case-control study, we included 1026 controls subjects in 2014–2017 in Hong Kong, China. Odds ratios (ORs) and 95% confidence intervals (CIs) of the association between UVR exposure and EBV VCA-IgA (seropositivity vs seronegativity) were calculated using unconditional logistic regression models adjusted for potential confounders.

Results

We observed a large increase in seropositivity of EBV VCA-IgA in association with duration of sunlight exposures at both 10 years before recruitment and age 19–30 years (adjusted OR = 3.59, 95% CI = 1.46–8.77; and adjusted OR = 2.44, 95% CI = 1.04–5.73 for ≥8 vs <2 hours/day; P for trend = .005 and .048, respectively). However, no association of EBV VCA-IgA serostatus with other indicators of UVR exposure was found. In addition, both circulating 25-hydroxyvitamin D (25OHD) and genetic predicted 25OHD were not associated with EBV VCA-IgA serostatus.

Conclusions

Our results suggest that personal UVR exposure may be associated with higher risk of EBV reactivation, but we did not find clear evidence of vitamin D exposure (observational or genetic), a molecular mediator of UVR exposure. Further prospective studies in other populations are needed to confirm this finding and to explore the underlying biological mechanisms. Information on photosensitizing agents, and serological markers of EBV, and biomarkers related to systemic immunity and inflammation should be collected and are also highly relevant in future studies.

Fifteen-year incidence rate and risk factors of pterygium in the Southern Indian state of Andhra Pradesh

PURPOSE

To report 15-year incidence rate and associated risk factors of pterygium among people aged 30 years and above at baseline in the rural clusters of longitudinal Andhra Pradesh Eye Disease Study (APEDS III).

METHODS

The baseline APEDS I included 7771 participants of which 6447 (83%) were traced and 5395 (83.7%) were re-examined in APEDS III. To estimate the incidence of pterygium, we selected participants who were 30 years and above at baseline (4188), of which 2976 were traced and 2627 (88.3%) were examined, and based on inclusion criteria, 2290 participants were included in the study. The incidence rate of pterygium was defined as the proportion of people free of pterygium at baseline who had developed the condition at 15-year follow-up (range 13-17 years). Univariate and multivariable analyses for risk factors were undertaken.

RESULTS

The sex-adjusted incidence rate of pterygium was 25.2 per 100 person-years (95% CI 24.8 to 25.7) which was significantly higher for men than women (26.3 per 100 person-years (95% CI 25.6 to 27.0) and 24.7 (95% CI 24.1 to 25.3) respectively). At the multivariable analysis, male gender (RR: 1.35, 95% CI 1.0 to 1.83), no formal education (RR: 2.46, 95% CI 1.22 to 4.93), outdoor occupation (RR: 1.47, 95% CI 1.14 to 1.9) and lower body mass index (BMI) (<18.5) (RR: 1.25, 95% CI 1.02 to 1.55) were associated with increased risk of pterygium.

CONCLUSIONS

The overall incidence rate of pterygium was high in this rural population, especially in men and those engaged in outdoor activities, lack of formal education and with lower BMI. It is likely that greater exposure to ultraviolet light is a major contributing factor, thus warranting preventive strategies.

Vitamin D status in preschool children and its relations to vitamin D sources and body mass index-Fish Intervention Studies-KIDS (FINS-KIDS)

OBJECTIVES

The aims of this study were to determine vitamin D status (serum 25-hydroxyvitamin D₃ [s-25(OH)D₃]) and examine possible associations between vitamin D status and vitamin D-rich dietary sources, sun exposure, and body mass index in preschool children ages 4 to 6 y.

METHODS

This is a cross-sectional study based on baseline data (collected in January-February 2015) from the two-armed randomized controlled trial Fish Intervention Studies-KIDS (FINS-KIDS) conducted in Bergen, Norway. S-25(OH)D₃ concentration was determined by liquid chromatography-tandem mass spectrometry. Information regarding habitual dietary intake, recent sun vacations, and body mass index were assessed with questionnaires answered by the children's caregivers.

RESULTS

The children (n = 212) had a mean (standard deviation) s-25(OH)D₃ of 60.7 (13.8) nmol/L; 18.9% had s-25(OH)D₃ ≤50 nmol/L. In logistic regression models, non-overweight versus overweight status was inversely associated with s-25(OH)D₃ ≤50 nmol/L (odds ratio: 0.41; 95% confidence interval, 0.18-0.95; P = 0.037). Non-sun versus sun vacations were associated with s-25(OH)D₃ ≤75 nmol/L (odds ratio: 5.33; 95% confidence interval, 1.93-14.77; P = 0.001).

CONCLUSIONS

The majority of the preschool children (81%) had s-25(OH)D₃ >50 nmol/L. Children with overweight status had an increased risk of s-25(OH)D₃ ≤50 nmol/L, and children who had not been on sun vacations were at a greater risk of s-25(OH)D₃ ≤75 nmol/L.

Solar Ultraviolet Radiation Exposure among Outdoor Workers in Three Canadian Provinces

Introduction

Solar ultraviolet radiation (UVR) exposure places outdoor workers at risk of skin cancer and exposure is difficult to control. In response, the Sun Safety at Work Canada (SSAWC) project was undertaken (2014–2016). The purpose of this substudy was to characterize the UVR exposure levels of outdoor workers in the SSAWC project.

Methods

Thirteen workplaces in the provinces of British Columbia, Ontario, and Nova Scotia participated in an exposure monitoring campaign (late summer/early fall 2016). Study participants were workers from power utilities and municipalities. Participants wore a UVR measurement badge (light-sensitive polysulfone plastic) on their wrist, shoulder, or hardhat. Badge calibration and absorbance measurements were performed in the AusSun Research Lab. Personal UVR doses are presented as standard erythemal doses (SED) and compared with the internationally recommended exposure limit (1.3 SED), as well as to the total available UVR by date. Generalized linear models were used to examine determinants of solar UVR for personal UVR dose (for both SED and percent of ambient UVR). Models considered badge placement, date, province, industry, main job task, and the hours spent outdoors.

Results

Mean personal UVR dose of participating workers was 6.1 SED (nearly 5× the recommended limit). Just 14% of workers experienced ‘acceptable’ levels of solar radiation; 10% were exposed at >10 times the limit. In univariate analyses, workers in Ontario had the highest levels (mean 7.3 SED), but even in the lowest exposed province (British Columbia), the mean personal UVR dose was 4.5 SED. Utility workers had double the exposure of municipal workers (10.4 and 5.5 SED, respectively). In the determinants of exposure models, the differences by province were muted, but utility line workers and those in general maintenance had higher predicted exposures. Those who wore their badge on their hardhat also had higher values of SED in the fully adjusted determinants models.

Conclusions

Solar ultraviolet overexposure among outdoor workers is a concern, even in a country like Canada with relatively low ambient UVR. Implementation of sun safety programs should be supported in an effort to reduce exposure in this vulnerable group of workers.

Effects of Radon and UV Exposure on Skin Cancer Mortality in Switzerland

BACKGROUND

Skin cancer incidence in Switzerland is among the highest in the world. In addition to exposure to ultraviolet (UV) radiation, radon alpha particles attached to aerosols can adhere to the skin and potentially cause carcinogenic effects.

OBJECTIVES

We investigated the effects of radon and UV exposure on skin cancer mortality.

METHODS

Cox proportional hazard regression was used to study the association between exposures and skin cancer mortality in adults from the Swiss National Cohort. Modeled radon exposure and erythemal-weighted UV dose were assigned to addresses at baseline. Effect estimates were adjusted for sex, civil status, mother tongue, education, job position, neighborhood socioeconomic position, and UV exposure from outdoor occupation.

RESULTS

The study included 5.2 million adults (mean age 48 y) and 2,989 skin cancer deaths, with 1,900 indicating malignant melanoma (MM) as the primary cause of death. Adjusted hazard ratios (HR) for MM at age 60 were 1.16 (95% CI: 1.04, 1.29) per 100 Bq/m3 radon and 1.11 (1.01, 1.23) per W/m2 in UV dose. Radon effects decreased with age. Risk of MM death associated with residential UV exposure was higher for individuals engaged in outdoor work with UV exposure (HR 1.94 [1.17, 3.23]), though not statistically significantly different compared to not working outdoors (HR 1.09 [0.99, 1.21], p=0.09).

CONCLUSIONS

There is considerable variation in radon and UV exposure across Switzerland. Our study suggests both are relevant risk factors for skin cancer mortality. A better understanding of the role of the UV radiation and radon exposure is of high public health relevance. https://doi.org/10.1289/EHP825.

Pregnancy outcome and ultraviolet radiation; A systematic review

BACKGROUND

Season and vitamin D are indirect and direct correlates of ultraviolet (UV) radiation and are associated with pregnancy outcomes. Further to producing vitamin D, UV has positive effects on cardiovascular and immune health that may support a role for UV directly benefitting pregnancy.

OBJECTIVES

To investigate the effects of UV exposure on pregnancy; specifically fetal growth, preterm birth and hypertensive complications.

METHODS

We conducted a systematic review of Medline, EMBASE, DoPHER, Global Health, ProQuest Public Health, AustHealth Informit, SCOPUS and Google Scholar to identify 537 citations, 8 of which are included in this review. This review was registered on PROSPERO and a. narrative synthesis is presented following PRISMA guidance.

RESULTS

All studies were observational and assessed at high risk of bias. Higher first trimester UV was associated with and improved fetal growth and increased hypertension in pregnancy. Interpretation is limited by study design and quality. Meta-analysis was precluded by the variety of outcomes and methods.

DISCUSSION

The low number of studies and risk of bias limit the validity of any conclusions. Environmental health methodological issues are discussed with consideration given to design and analytical improvements to further address this reproductive environmental health question.

CONCLUSIONS

The evidence for UV having benefits for pregnancy hypertension and fetal growth is limited by the methodological approaches utilized. Future epidemiological efforts should focus on improving the methods of modeling and linking widely available environmental data to reproductive health outcomes.

Mapping Global Potential Risk of Establishment of Rhagoletis pomonella (Diptera: Tephritidae) Using MaxEnt and CLIMEX Niche Models

The apple maggot, Rhagoletis pomonella (Walsh) (Diptera: Tephritidae), is a major quarantine pest of apples (Malus domestica Borkhausen) in the United States. Apple maggot is found only in North America and negatively impacts the apple industry in the western United States by reducing grower access to export markets. To reduce the threat of apple maggot to export countries and to facilitate the movement of commercial apples, an assessment of potential risk of establishment of apple maggot is needed to predict which regions are suitable or unsuitable for the fly. We used a correlative niche model MaxEnt and a mechanistic model CLIMEX to model global potential risk of establishment of apple maggot. The MaxEnt model was developed by integrating apple maggot occurrences with global climatic variables. Apple (a major host of apple maggot) climatic suitability was used as an additional variable to include species interactions in the MaxEnt model. The CLIMEX model was developed using published apple maggot physiological tolerance thresholds. Both the MaxEnt and CLIMEX models correctly predicted the known distribution of apple maggot in North America, met biological expectations when projected to the world, and mostly agreed on climatic suitability worldwide for the fly. Degree-days at 6.7 °C, elevation, precipitation seasonality, and apple climatic suitability were the most important predictors associated with apple maggot distribution in North America. Our results can be used to make science-based international trade decisions by policy makers, and for monitoring apple maggot potential introductions in countries where it currently does not occur.

Levels of Occupational Exposure to Solar Ultraviolet Radiation in Vancouver, Canada

INTRODUCTION

Outdoor workers are at high risk of exposure to solar ultraviolet radiation (UVR), a known human carcinogen. In Canada, no objective measures of UVR exposure are available for occupational settings.

METHODS

The Outdoor Workers Project collected UVR exposure data among outdoor workers in Vancouver, Canada during the summer of 2013. Objective measures of exposure were taken for one week using calibrated electronic UVR dosimeters. Additional data was collected from workers on skin cancer risk factors, family history of skin cancer, and job type; as well as meteorological data for sampling days. Marginal models were constructed to examine the worker, job and meteorological determinants of UVR exposure levels, as measured in standard erythemal dose (SED).

RESULTS

Seventy-eight workers were recruited, of which 73 had at least 1 day of measured UVR exposure for this analysis. Participants were mostly male, young and Caucasian. Mean exposure (corrected for repeated measures) was 1.08 SED. Exposure measures were highly variable even in the same workplace, ranging from 0.01 SED to 19.2 SED. Younger age, working in land-based construction, and sunnier weather forecasts led to higher levels of UVR exposure.

CONCLUSIONS

Exposure levels capable of causing sunburn were common in this study of outdoor workers, in a location not typically associated with high sun exposure.

Urban and transport planning, environmental exposures and health-new concepts, methods and tools to improve health in cities

BACKGROUND

The majority of people live in cities and urbanization is continuing worldwide. Cities have long been known to be society's predominant engine of innovation and wealth creation, yet they are also a main source of pollution and disease.

METHODS

We conducted a review around the topic urban and transport planning, environmental exposures and health and describe the findings.

RESULTS

Within cities there is considerable variation in the levels of environmental exposures such as air pollution, noise, temperature and green space. Emerging evidence suggests that urban and transport planning indicators such as road network, distance to major roads, and traffic density, household density, industry and natural and green space explain a large proportion of the variability. Personal behavior including mobility adds further variability to personal exposures, determines variability in green space and UV exposure, and can provide increased levels of physical activity. Air pollution, noise and temperature have been associated with adverse health effects including increased morbidity and premature mortality, UV and green space with both positive and negative health effects and physical activity with many health benefits. In many cities there is still scope for further improvement in environmental quality through targeted policies. Making cities 'green and healthy' goes far beyond simply reducing CO2 emissions. Environmental factors are highly modifiable, and environmental interventions at the community level, such as urban and transport planning, have been shown to be promising and more cost effective than interventions at the individual level. However, the urban environment is a complex interlinked system. Decision-makers need not only better data on the complexity of factors in environmental and developmental processes affecting human health, but also enhanced understanding of the linkages to be able to know at which level to target their actions. New research tools, methods and paradigms such as geographical information systems, smartphones, and other GPS devices, small sensors to measure environmental exposures, remote sensing and the exposome paradigm together with citizens observatories and science and health impact assessment can now provide this information.

CONCLUSION

While in cities there are often silos of urban planning, mobility and transport, parks and green space, environmental department, (public) health department that do not work together well enough, multi-sectorial approaches are needed to tackle the environmental problems. The city of the future needs to be a green city, a social city, an active city, a healthy city.

Sun behaviour and personal UVR exposure among Europeans on short term holidays

Solar ultraviolet radiation (UVR) is known to be the main cause of skin cancer, the incidence of which is rising with national differences across Europe. With this observation study we aimed to determine the impact of nationality on sun behaviour and personal UVR exposure on sun and ski holidays. 25 Danish and 20 Spanish sun-seekers were observed during a sun holiday in Spain, and 26 Danish and 27 Austrian skiers were observed during a ski holiday in Austria. The participants recorded their location and clothing in diaries. Personal time-logged UVR data were recorded as standard erythema doses (SEDs) by an electronic UVR dosimeter worn on the wrist. Danish sun-seekers were outdoors for significantly longer, received significant higher percentages of ambient UVR, and received greater accumulated UVR doses than Spanish sun-seekers. Danish skiers were also outdoors for significantly longer than Austrian skiers, but the behaviour of the Danish skiers did not result in significantly greater accumulated UVR doses. Both Danish and Spanish sun-seekers and Danish and Austrian skiers received substantial UVR doses. The behaviour's influence on the UVR doses received by the Danish participants may indicate an explanation of the higher skin cancer incidence among Scandinavians compared with other European populations.

Assessing the Global Risk of Establishment of Cydia pomonella (Lepidoptera: Tortricidae) using CLIMEX and MaxEnt Niche Models

Accurate assessment of insect pest establishment risk is needed by national plant protection organizations to negotiate international trade of horticultural commodities that can potentially carry the pests and result in inadvertent introductions in the importing countries. We used mechanistic and correlative niche models to quantify and map the global patterns of the potential for establishment of codling moth (Cydia pomonella L.), a major pest of apples, peaches, pears, and other pome and stone fruits, and a quarantine pest in countries where it currently does not occur. The mechanistic model CLIMEX was calibrated using species-specific physiological tolerance thresholds, whereas the correlative model MaxEnt used species occurrences and climatic spatial data. Projected potential distribution from both models conformed well to the current known distribution of codling moth. None of the models predicted suitable environmental conditions in countries located between 20°N and 20°S potentially because of shorter photoperiod, and lack of chilling requirement (<60 d at ≤10°C) in these areas for codling moth to break diapause. Models predicted suitable conditions in South Korea and Japan where codling moth currently does not occur but where its preferred host species (i.e., apple) is present. Average annual temperature and latitude were the main environmental variables associated with codling moth distribution at global level. The predictive models developed in this study present the global risk of establishment of codling moth, and can be used for monitoring potential introductions of codling moth in different countries and by policy makers and trade negotiators in making science-based decisions.

Sun and ski holidays improve vitamin D status, but are associated with high levels of DNA damage

Skin cancer is caused by solar UVR, which is also essential for vitamin D production. DNA damage (thymine dimers: T-T dimers) and vitamin D (25(OH)D) synthesis are both initiated by solar UVB. We aimed to investigate the simultaneous adverse and beneficial effects of solar UVB exposure in holidaymakers. Sun-seekers and skiers (n=71) were observed over 6 days through on-site monitoring, personal diary entries, and recording of personal UVB exposure doses with electronic dosimeters. Urine and blood samples were analyzed for T-T dimers and 25(OH)D, respectively. The volunteers had a statistically significant increase in vitamin D. There were strong associations between UVB exposure and post-holiday levels of T-T dimers and vitamin D, as well as between post-holiday T-T dimers and vitamin D. We conclude that UVB-induced vitamin D synthesis is associated with considerable DNA damage in the skin. These data, on two major health predictors, provide a basis for further field studies that may result in better understanding of the risks and benefits of "real life" solar exposure. However, vitamin D status can be improved more safely through the use of vitamin D dietary supplements.

Shedding light on UVR and Hodgkin lymphoma

In this issue of Blood, Monnereau and colleagues pool 4 retrospective (case-control), observational epidemiologic studies to demonstrate an inverse association between UV radiation (UVR) exposure and risk of developing Hodgkin lymphoma (HL).

Individual, environmental, and meteorological predictors of daily personal ultraviolet radiation exposure measurements in a United States cohort study

BACKGROUND

Individual exposure to ultraviolet radiation (UVR) is challenging to measure, particularly for diseases with substantial latency periods between first exposure and diagnosis of outcome, such as cancer. To guide the choice of surrogates for long-term UVR exposure in epidemiologic studies, we assessed how well stable sun-related individual characteristics and environmental/meteorological factors predicted daily personal UVR exposure measurements.

METHODS

We evaluated 123 United States Radiologic Technologists subjects who wore personal UVR dosimeters for 8 hours daily for up to 7 days (N = 837 days). Potential predictors of personal UVR derived from a self-administered questionnaire, and public databases that provided daily estimates of ambient UVR and weather conditions. Factors potentially related to personal UVR exposure were tested individually and in a model including all significant variables.

RESULTS

The strongest predictors of daily personal UVR exposure in the full model were ambient UVR, latitude, daily rainfall, and skin reaction to prolonged sunlight (R(2) = 0.30). In a model containing only environmental and meteorological variables, ambient UVR, latitude, and daily rainfall were the strongest predictors of daily personal UVR exposure (R(2) = 0.25).

CONCLUSIONS

In the absence of feasible measures of individual longitudinal sun exposure history, stable personal characteristics, ambient UVR, and weather parameters may help estimate long-term personal UVR exposure.