Moderate increases in ambient PM2.5 and ozone are associated with lung function decreases in beach lifeguards

Unique regulatory roles of ncRNAs changed by PM2.5 in human diseases

PM_2.5 is a type of particulate matter with an aerodynamic diameter smaller than 2.5 µm, and exposure to PM_2.5 can adversely damage human health. PM_2.5 may impair health through oxidative stress, inflammatory reactions, immune function alterations and chromosome or DNA damage. Through increasing in-depth studies, researchers have found that noncoding RNAs (ncRNAs), particularly microRNAs (miRNAs), circular RNAs (circRNAs) as well as long noncoding RNAs (lncRNAs), might play significant roles in PM_2.5-related human diseases via some of the abovementioned mechanisms. Therefore, in this review, we mainly discuss the regulatory function of ncRNAs altered by PM_2.5 in human diseases and summarize the potential molecular mechanisms. The findings reveal that these ncRNAs might induce or promote diseases via inflammation, the oxidative stress response, cell autophagy, apoptosis, cell junction damage, altered cell proliferation, malignant cell transformation, disruption of synaptic function and abnormalities in the differentiation and status of immune cells. Moreover, according to a bioinformatics analysis, the altered expression of potential genes caused by these ncRNAs might be related to the development of some human diseases. Furthermore, some ncRNAs, including lncRNAs, miRNAs and circRNAs, or processes in which they are involved may be used as biomarkers for relevant diseases and potential targets to prevent these diseases. Additionally, we performed a meta-analysis to identify more promising diagnostic ncRNAs as biomarkers for related diseases.

The role of PP2A /NLRP3 signaling pathway in ambient particulate matter 2.5 induced lung injury

Ambient particulate matter 2.5 (PM_2.5) exposure has been linked to pulmonary fibrosis. However, the key signaling pathways remained unclear. In the present study, we applied a mouse model with myeloid-specific deletion of Ppp2r1a gene (encoding protein phosphatase 2 A (PP2A) A subunit) to identify the key signaling pathways involved in PM_2.5-induced pulmonary fibrosis. PP2A Aα^-/- homozygote mice and matched wild-type (WT) littermates were exposed to filtered air (FA), unfiltered air (UA), and concentrated PM_2.5 (CA) in a real-ambient PM exposure system for 8 weeks and 16 weeks, respectively. The mice exposed to PM_2.5 displayed a progressive inflammation and pulmonary fibrosis. Moreover, the expressions of NLRP3, pro-caspase-1, caspase-1, ASC and IL-1β were increased in mice lung following PM_2.5 exposure, indicating PM_2.5 exposure caused pulmonary inflammation by the NLRP3 pathways activation. Furthermore, the effects of PM exposure on pulmonary inflammation, pulmonary fibrosis, oxidative stress, and pulmonary function damage were significantly enhanced in PP2A^-/- mice compared to WT mice, indicating the role of PP2A in the regulation of pulmonary injury induced by PM exposure. In vitro study confirmed that PP2A was involved in the PM_2.5-induced inflammation response and NLRP3 inflammasome activation. Importantly, we identified PP2A regulated the activation of NLRP3 pathways by direct dephosphorylating IRE1α in response to PM_2.5 exposure. Taken together, our results demonstrated that PP2A-IRE1α-NLRP3 signaling pathway played a crucial role in regulating the inflammation response, triggering the lung fibrogenesis upon PM_2.5 exposure. Our findings provide new insights into regulatory role of PP2A in human diseases upon the PM exposure.

Acute exercise in ozone-polluted air induces apoptosis in rat quadriceps femoris muscle cells via mitochondrial pathway

Ozone (O₃) pollution can decrease sport performance and induce respiratory toxicity, but relatively few studies have investigated its effects on skeletal muscles. We randomly assigned rats to the following groups based on a 2 ​× ​4 two-factor factorial design: Air+0, Air+10, Air+15, and Air+20, O₃+0, O₃+10, O₃+15, and O₃+20. The rats in the +0 groups rested, whereas those in the +10, +15, and +20 groups ran on a treadmill (in clean air for Air groups and in air polluted with 0.14 ​parts per million [ppm] O₃ for O₃ groups) at speeds of 10, 15, and 20 ​m/min, respectively, for 1 ​h. Thereafter, key enzyme activities involving the tricarboxylic acid cycle, oxidative phosphorylation, adenosine triphosphate (ATP) content, histopathological changes, oxidative stress, inflammation factors, and apoptosis were assessed in the rat quadriceps femoris samples. Ozone reduced key enzyme activities and ATP contents in the quadriceps femoris regardless of whether the rats exercised. Pathological changes, inflammatory factors, oxidative stress, and mitochondria-dependent apoptosis were only evident under conditions of exercise combined with ozone and increasingly worsened as exercise intensity increased. These findings suggested that acute exercise under ozone exposure could induce damage to the quadriceps femoris, which would negatively affect sport performance. Ozone-induced disrupted energy metabolism might be an early event that becomes more critical as exercise intensity increases. Therefore, care should be taken when exercising in polluted air, even when ozone pollution is mild.

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O₃ itself inhibited key enzyme activities in TCA and oxidative phosphorylation.

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O₃ decreased ATP production regardless of whether it was coupled with exercise.

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Acute exercise in O₃ polluted air induced oxidative stress, inflammatory reaction.

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Acute exercise in O₃ polluted air caused mitochondria-mediated apoptosis.

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O₃ and exercise synergistically regulated levels of IL-2, IL-6 and 8-OHdG in muscles.

Easy Breathing: A Review of the Impact of Air Quality on Pediatric Health Outcomes

Preventable environmental factors such as exposure to poor air quality are predicted to affect 23% of all global deaths. Although there have been efforts to reduce air pollution through federal guidelines for vehicle and industrial emissions, the air in the United States remains far from clean. Children and pregnant women have been identified as high-risk populations who are particularly susceptible to the negative effects of poor air quality. This paper provides an overview of health concerns related to poor air quality, pediatric considerations from pregnancy through childhood, the importance of increased awareness of air quality assessment and prevention in patient encounters, and current advocacy efforts and legislation.

Environmental and Occupational Short-Term Exposure to Airborne Particles and FEV1 and FVC in Healthy Adults: A Systematic Review and Meta-Analysis

Background: No study has compared the respiratory effects of environmental and occupational particulate exposure in healthy adults. Methods: We estimated, by a systematic review and meta-analysis, the associations between short term exposures to fine particles (PM_2.5 and PM₄) and certain parameters of lung function (FEV₁ and FVC) in healthy adults. Results: In total, 33 and 14 studies were included in the qualitative synthesis and meta-analyses, respectively. In environmental studies, a 10 µg/m³ increase in PM_2.5 was associated with an FEV₁ reduction of 7.63 mL (95% CI: −10.62 to −4.63 mL). In occupational studies, an increase of 10 µg/m³ in PM₄ was associated with an FEV₁ reduction of 0.87 mL (95% CI: −1.36 to −0.37 mL). Similar results were observed with FVC. Conclusions: Both occupational and environmental short-term exposures to fine particles are associated with reductions in FEV₁ and FVC in healthy adults.

Low levels of fine particulate matter increase vascular damage and reduce pulmonary function in young healthy adults

BACKGROUND

Fine particulate matter (PM2.5) related mild inflammation, altered autonomic control of cardiovascular function, and changes to cell function have been observed in controlled human exposure studies.

METHODS

To measure the systemic and cardiopulmonary impacts of low-level PM exposure, we exposed 20 healthy, young volunteers to PM2.5, in the form of concentrated ambient particles (mean: 37.8 μg/m3, SD 6.5), and filtered air (mean: 2.1 μg/m3, SD 2.6). In this double-blind, crossover study the exposure order was randomized. During the 4 h exposure, volunteers (7 females and 13 males) underwent light intensity exercise to regulate ventilation rate. We measured pulmonary, cardiac, and hematologic end points before exposure, 1 h after exposure, and again 20 h after exposure.

RESULTS

Low-level PM2.5 resulted in both pulmonary and extra-pulmonary changes characterized by alterations in systematic inflammation markers, cardiac repolarization, and decreased pulmonary function. A mean increase in PM2.5 concentration (37.8 μg/m3) significantly increased serum amyloid A (SAA), C-reactive protein (CRP), soluble intercellular adhesion molecule-1 (sICAM-1), and soluble vascular cell adhesion molecule-1 (sVCAM-1), 1 h after exposure by 8.7, 9.1, 10.7, and 6.6%, respectively, relative to the filtered air control. SAA remained significantly elevated (34.6%) 20 h after PM2.5 exposure which was accompanied by a 5.7% decrease in percent neutrophils. Decreased pulmonary function was observed 1 h after exposure through a 0.8 and 1.2% decrease in forced expiratory volume in 1 s (FEV1) and FEV1/ forced vital capacity (FEV1/FVC) respectively. Additionally, sex specific changes were observed in repolarization outcomes following PM2.5 exposure. In males, P-wave and QRS complex were increased by 15.4 and 5.4% 1 h after exposure.

CONCLUSIONS

This study is the first controlled human exposure study to demonstrate biological effects in response to exposure to concentrated ambient air PM2.5 particles at levels near the PM2.5 US NAAQS standard.

CLINICAL TRIAL REGISTRATION INFORMATION

clinicaltrials.gov ; Identifier: NCT03232086 . The study was registered retrospectively on July 25, 2017, prior to final data collection on October 25, 2017 and data analysis.

A Robust Deep Learning Approach for Spatiotemporal Estimation of Satellite AOD and PM2.5

Accurate estimation of fine particulate matter with diameter ≤2.5 μm (PM2.5) at a high spatiotemporal resolution is crucial for the evaluation of its health effects. Previous studies face multiple challenges including limited ground measurements and availability of spatiotemporal covariates. Although the multiangle implementation of atmospheric correction (MAIAC) retrieves satellite aerosol optical depth (AOD) at a high spatiotemporal resolution, massive non-random missingness considerably limits its application in PM2.5 estimation. Here, a deep learning approach, i.e., bootstrap aggregating (bagging) of autoencoder-based residual deep networks, was developed to make robust imputation of MAIAC AOD and further estimate PM2.5 at a high spatial (1 km) and temporal (daily) resolution. The base model consisted of autoencoder-based residual networks where residual connections were introduced to improve learning performance. Bagging of residual networks was used to generate ensemble predictions for better accuracy and uncertainty estimates. As a case study, the proposed approach was applied to impute daily satellite AOD and subsequently estimate daily PM2.5 in the Jing-Jin-Ji metropolitan region of China in 2015. The presented approach achieved competitive performance in AOD imputation (mean test R2: 0.96; mean test RMSE: 0.06) and PM2.5 estimation (test R2: 0.90; test RMSE: 22.3 μg/m3). In the additional independent tests using ground AERONET AOD and PM2.5 measurements at the monitoring station of the U.S. Embassy in Beijing, this approach achieved high R2 (0.82–0.97). Compared with the state-of-the-art machine learning method, XGBoost, the proposed approach generated more reasonable spatial variation for predicted PM2.5 surfaces. Publically available covariates used included meteorology, MERRA2 PBLH and AOD, coordinates, and elevation. Other covariates such as cloud fractions or land-use were not used due to unavailability. The results of validation and independent testing demonstrate the usefulness of the proposed approach in exposure assessment of PM2.5 using satellite AOD having massive missing values.

The acute health effects of ozone and PM2.5 on daily cardiovascular disease mortality: A multi-center time series study in China

To explore the acute health effects of ozone(O₃) and PM_2.5 on daily cardiovascular disease mortality in all the cities of Jiangsu province, China. Daily average concentrations of ozone (maximum 8-h average), fine particle matter (PM_2.5), meteorological data (including temperature and relative humidity) and daily cardiovascular diseases mortality data were collected from January 1, 2015, to December 31, 2017, in all the 13 cities of Jiangsu Province in China. The time-series model linked with Poisson distribution was used to estimate the correlation between O₃ and daily cardiovascular diseases mortality, after adjusting for PM_2.5 and other pollutants. Firstly, we evaluated the acute effects of O₃ on cardiovascular mortality in each city in Jiangsu province, and then we combined the effects of O₃ on cardiovascular disease mortality by meta-analysis. The single-pollutant model indicated that the acute health effects of O₃ in different cities were quite different. After combined the effects of 13 cities, the mortality of cardiovascular diseases increased by 0.983%（95%CI：0.588-1.377%）for every 10 μg/m³ increases of O₃. O₃ showed the strongest effect on 3-day moving average concentration (Lag 0-3). After adjusting PM_2.5，NO₂, SO₂, and CO, the results were still statistically significant at the multi-city level. The study found that O₃ had a greater effect on women; the elderly population was susceptible and high-education groups were more vulnerable to O₃, although the differences between different subgroups were insignificant. The dose-response curve showed that the mortality of cardiovascular disease increased with the increase of O₃. The increase in O₃ concentration of atmospheric can increase the daily mortality of cardiovascular diseases in Jiangsu, China.

Effects of individual ozone exposure on lung function in the elderly: a cross-sectional study in China

The aim of this study was to assess the acute health effects of individual ozone (O₃) exposure on the respiratory system in the elderly. A total of 40 non-smoking elderly volunteers completed personal 24 h of measurement for O₃ and fine particulate matter (PM_2.5). To assess health effects, we measured the pulmonary function and five inflammatory biomarkers in exhaled breath condensate (EBC), including interleukin-2 (IL-2), interferon-γ (IFN-γ), prostaglandin E₂ (PGE₂), and tumor necrosis factor α/β (TNFα/β). We used the generalized additive model to analyze the association between O₃ and these health effects, after adjusting PM_2.5, BMI, and sex as confounders. As a result, we found a negative correlation between O₃ and forced vital capacity (FVC) or forced expiratory volume-one second (FEV1). With the increasing of O₃ by 10 μg/m³, FVC and FEV1 decreased by 0.13 L (95% CI 0.01, 0.26) and 0.11 L (95% CI 0.02, 0.20), respectively. We found no statistical significance between O₃ and biomarkers in EBC. The results suggested that individual 24-h O₃ exposure was associated with decreased pulmonary function in the elderly.

Effects of Indoor and Ambient Black Carbon and [Formula: see text] on Pulmonary Function among Individuals with COPD

BACKGROUND

Particulate matter (PM) air pollution has been associated with decreased pulmonary function, but the exposure–response relationship in chronic obstructive pulmonary disease (COPD) patients is uncertain, and most studies have only focused on exposures to ambient pollution.

OBJECTIVES

We aimed to assess associations between pulmonary function and indoor and ambient PM [Formula: see text] ([Formula: see text]) and black carbon (BC).

METHODS

Between November 2012 and December 2014, 125 patients with COPD (mean age, 73.4 y) who were not currently smoking and without known indoor BC sources were recruited. Indoor BC and [Formula: see text] were measured in each home for a week in each season, up to four times a year, followed by in-person spirometry pre- and post-bronchodilator. Ambient exposures were available from a central site monitor. Multivariable adjusted mixed effects regression models were used to assess associations scaled per interquartile range (IQR) of exposure.

RESULTS

There were 367 study visits; the median (IQR) indoor BC and [Formula: see text] were 0.19 (0.22) [Formula: see text] and 6.67 (5.80) [Formula: see text], respectively. Increasing indoor exposures to BC were associated with decreases in pre-bronchodilator forced expiratory volume in 1 s [Formula: see text] and forced vital capacity (FVC), and [Formula: see text]. For example, in multivariable adjusted models, each IQR increase in indoor BC from the weekly integrated filter was associated with a [Formula: see text] [95% confidence interval (CI): [Formula: see text], [Formula: see text]] decrease in pre-bronchodilator [Formula: see text]. Increases in indoor [Formula: see text] were associated with decreases in [Formula: see text] and FVC of smaller magnitude than those for indoor BC; however, the results were less precise. Ambient BC was not associated with pre-bronchodilator pulmonary function, ambient [Formula: see text] was only associated with decreases in FVC and increases in [Formula: see text], and neither indoor nor ambient BC or [Formula: see text] were associated with post-bronchodilator pulmonary function.

CONCLUSIONS

Low-level exposures to indoor BC and [Formula: see text], but not ambient exposures, were consistently associated with decreases in pre-bronchodilator pulmonary function. There was no association between exposures and post-bronchodilator pulmonary function. https://doi.org/10.1289/EHP3668.

The effects of ozone on human health

Ozone is a highly reactive, oxidative gas associated with adverse health outcome, including mortality and morbidity. Data from monitoring sites worldwide show levels of ozone often exceeding EU legislation threshold and the more restrictive WHO guidelines for the protection of human health. Well-established evidence has been produced for short-term effects, especially on respiratory and cardiovascular systems, associated to ozone exposure. Less conclusive is the evidence for long-term effects, reporting suggestive associations with respiratory mortality, new-onset asthma in children and increased respiratory symptom effects in asthmatics. The growing epidemiological evidence and the increasing availability of routinely collected data on air pollutant concentrations and health statistics allow to produce robust estimates in health impact assessment routine. Most recent estimates indicate that in 2013 in EU-28, 16,000 premature deaths, equivalent to 192,000 years of life lost, are attributable to ozone exposure. Italy shows very high health impact estimates among EU countries, reporting 3380 premature deaths and 61 years of life lost (per 100,000 inhabitants) attributable to ozone exposure.

Ambient ozone and asthma hospital admissions in Texas: a time-series analysis

Background

Many studies have evaluated associations between asthma emergency department (ED) visits, hospital admissions (HAs), and ambient ozone (O₃) across the US, but not in Texas. We investigated the relationship between O₃ and asthma HAs, and the potential impacts of outdoor pollen, respiratory infection HAs, and the start of the school year in Texas.

Methods

We obtained daily time-series data on asthma HAs and ambient O₃ concentrations for Dallas, Houston, and Austin, Texas for the years 2003–2011. Relative risks (RRs) and 95% confidence intervals (CIs) of asthma HAs per 10-ppb increase in 8-h maximum O₃ concentrations were estimated from Poisson generalized additive models and adjusted for temporal trends, meteorological factors, pollen, respiratory infection HAs, day of the week, and public holidays. We conducted a number of sensitivity analyses to assess model specification.

Results

We observed weak associations between total asthma HAs and O₃ at lags of 1 day (RR_{10 ppb} = 1.012, 95% CI: 1.004–1.021), 2 days (RR_{10 ppb} = 1.011, 95% CI: 1.002–1.019), and 0–3 days (RR_{10 ppb} = 1.017, 95% CI: 1.005–1.030). The associations were primarily observed in children aged 5–14 years (e.g., for O₃ at lag 0–3 days, RR_{10 ppb} = 1.037, 95% CI: 1.011–1.064), and null in individuals 15 years or older. The effect estimates did not change significantly with adjustment for pollen and respiratory infections, but they attenuated considerably and lost statistical significance when August and September data were excluded. A significant interaction between time around the start of the school year and O₃ at lag 2 day was observed, with the associations with pediatric asthma HAs stronger in August and September (RR_{10 ppb} = 1.040, 95% CI: 1.012–1.069) than in the rest of the year (October–July) (RR_{10 ppb} = 1.006, 95% CI: 0.986–1.026).

Conclusions

We observed small but statistically significant positive associations between total and pediatric asthma HAs and short-term O₃ exposure in Texas, especially in August and September. Further research is needed to determine how the start of school could modify the observed association between O₃ and pediatric asthma HAs.

Electronic supplementary material

The online version of this article (doi:10.1186/s40733-017-0034-1) contains supplementary material, which is available to authorized users.

Injuries and exposures among ocean safety providers: A review of workplace injuries and exposures from 2007-2012

Research on workplace injuries and exposures in ocean safety personnel remains limited. Despite increasing beach attendance and reliance on lifeguards for protection, the most common types of injuries, equipment resulting in injuries, and environmental exposures remains unknown. This study reviewed OSHA 300 logs summarizing workers' compensation claims from 2007-2012 to identify common body parts injured, action at time of injury, equipment causing injury, and environmental exposures. A secondary phase consisted of a cross-sectional anonymous survey to determine demographics, body part injured, equipment causing injury, sun and environmental exposures, action at time of injury, and proportion of injuries reported to the department. During the 6-year period, 304 claims from the OSHA logs were reviewed, finding the lower extremity was most commonly injured with 2921 (31.9%) cumulative lost work days (104 reported injured, 34.2%) followed by the back with 1679 (18.4%) lost work days (39 reported injuries, 12.8%). Of the 304 occupational injury claims from OSHA logs, 108 incidents (35.5%) occurred during rescues, 87 (28.6%) during normal duties, and 31 (10.2%) during training. Of survey participants, 22/52 sustained an injury, with 14 filling a worker's compensation claim. The rescueboard resulted in 7/22 injuries (31.8%) while 17 (32.7%) of respondents sought care for a sun related concern with a mean of 9.3 days lost. Occupational injuries in ocean safety personnel are largely unknown. In this study, lower extremity and back injuries were the most common musculoskeletal injuries providers encountered. Rescues and moving equipment were common actions at the time of injury. With this preliminary information, jurisdictions may develop training directed at rescue techniques and safer options for moving heavy equipment.

Mycoplasma pneumoniae and health outcomes in children with asthma

BACKGROUND

Acute infections with Mycoplasma pneumoniae (Mp) have been associated with worsening asthma in children. Mp can be present in the respiratory tract for extended periods; it is unknown whether the long-term persistence of Mp in the respiratory tract affects long-term asthma control.

OBJECTIVE

To determine the effect of Mp on asthma control.

METHODS

We enrolled 31 pediatric subjects 3 to 10 years of age with persistent asthma who completed up to 8 visits over a 24-month period. We detected Mp by antigen capture and polymerase chain reaction. Primary outcome measurements included symptom scores, quality of life, medication scores, oral corticosteroid use, health care usage, school absences, and exhaled breath condensate pH.

RESULTS

Low levels of Mp community-acquired respiratory distress syndrome toxin were detected in 20 subjects (64.5%) at enrollment. Subjects with Mp positivity at a given visit had a .579 probability of remaining Mp positive at the subsequent visit, whereas those with Mp negativity had a .348 probability of becoming Mp positive at the following visit. The incidence of Mp overall was higher in the spring and summer months. Overall, we found no significant relation between the detection of Mp and worse outcome measurements at the same visit or at subsequent visits.

CONCLUSION

The long-term persistence of Mp in the respiratory tract is common in children with asthma. However, the detection of Mp was not associated significantly with worse asthma symptoms, quality of life, health care usage, school absences, or exhaled breath condensate pH in this pediatric asthma cohort.

The health effects of ambient PM2.5 and potential mechanisms

The impacts of ambient PM2.5 on public health have become great concerns worldwide, especially in the developing countries. Epidemiological and toxicological studies have shown that PM2.5 does not only induce cardiopulmonary disorders and/or impairments, but also contributes to a variety of other adverse health effects, such as driving the initiation and progression of diabetes mellitus and eliciting adverse birth outcomes. Of note, recent findings have demonstrated that PM2.5 may still pose a hazard to public health even at very low levels (far below national standards) of exposure. The proposed underlying mechanisms whereby PM2.5 causes adverse effects to public health include inducing intracellular oxidative stress, mutagenicity/genotoxicity and inflammatory responses. The present review aims to provide an brief overview of new insights into the molecular mechanisms linking ambient PM2.5 exposure and health effects, which were explored with new technologies in recent years.

Association between outdoor ozone and compensated acute respiratory diseases among workers in Quebec (Canada)

Respiratory effects of ozone in the workplace have not been extensively studied. Our aim was to explore the relationship between daily average ozone levels and compensated acute respiratory problems among workers in Quebec between 2003 and 2010 using a time-stratified case-crossover design. Health data came from the Workers' Compensation Board. Daily concentrations of ozone were estimated using a spatiotemporal model. Conditional logistic regressions, with and without adjustment for temperature, were used to estimate odds ratios (ORs, per 1 ppb increase of ozone), and lag effects were assessed. Relationships with respiratory compensations in all industrial sectors were essentially null. Positive non-statistically significant associations were observed for outdoor sectors, and decreased after controlling for temperature (ORs of 0.98; 1.01 and 1.05 at Lags 0, 1 and 2 respectively). Considering the predicted increase of air pollutant concentrations in the context of climate change, closer investigation should be carried out on outdoor workers.

Evaluating potential response-modifying factors for associations between ozone and health outcomes: a weight-of-evidence approach

BACKGROUND

Epidemiologic and experimental studies have reported a variety of health effects in response to ozone (O3) exposure, and some have indicated that certain populations may be at increased or decreased risk of O3-related health effects.

OBJECTIVES

We sought to identify potential response-modifying factors to determine whether specific groups of the population or life stages are at increased or decreased risk of O3-related health effects using a weight-of-evidence approach.

METHODS

Epidemiologic, experimental, and exposure science studies of potential factors that may modify the relationship between O3 and health effects were identified in U.S. Environmental Protection Agency's 2013 Integrated Science Assessment for Ozone and Related Photochemical Oxidants. Scientific evidence from studies that examined factors that may influence risk were integrated across disciplines to evaluate consistency, coherence, and biological plausibility of effects. The factors identified were then classified using a weight-of-evidence approach to conclude whether a specific factor modified the response of a population or life stage, resulting in an increased or decreased risk of O3-related health effects.

DISCUSSION

We found "adequate" evidence that populations with certain genotypes, preexisting asthma, or reduced intake of certain nutrients, as well as different life stages or outdoor workers, are at increased risk of O3-related health effects. In addition, we identified other factors (i.e., sex, socioeconomic status, and obesity) for which there was "suggestive" evidence that they may increase the risk of O3-related health effects.

CONCLUSIONS

Using a weight-of-evidence approach, we identified a diverse group of factors that should be considered when characterizing the overall risk of health effects associated with exposures to ambient O3.

Community-based interventions in asthma

Community and public health interventions provide potentially powerful means of decreasing morbidity, hospitalizations, emergency room visits, and mortality from asthma. This chapter thus provides an overview of community-based interventions, which have been demonstrated to be effective-and/or ineffective-in reducing the burden of disease, including development of asthma coalitions, interventions for both provider and patient education, environmental controls to reduce exposure to asthma triggers, and institutional policy and systems change. Perhaps most important is the demonstrated effect of integrated, comprehensive approaches to asthma management and control. A multidisciplinary approach spanning T1 through T4 translational research, coupled with public health activities is promising and has already demonstrated success in reducing the burden of disease.

A growing role for gender analysis in air pollution epidemiology

Epidemiologic studies of air pollution effects on respiratory health report significant modification by sex, although results are not uniform. Importantly, it remains unclear whether modifications are attributable to socially derived gendered exposures, to sex-linked physiological differences, or to some interplay thereof. Gender analysis, which aims to disaggregate social from biological differences between males and females, may help to elucidate these possible sources of effect modification. Studies of children suggest stronger effects among boys in early life and among girls in later childhood. The qualitative review describes possible sources of difference in air pollution response between women and men, which may vary by life stage, coexposures, hormonal status, or other factors. The sources of observed effect modifications remain unclear, although gender analytic approaches may help to disentangle gender and sex differences in pollution response. A framework for incorporating gender analysis into environmental epidemiology is offered, along with several potentially useful methods from gender analysis.

A growing role for gender analysis in air pollution epidemiology

OBJECTIVE

Epidemiologic studies of air pollution effects on respiratory health report significant modification by sex, although results are not uniform. Importantly, it remains unclear whether modifications are attributable to socially derived gendered exposures, to sex-linked physiological differences, or to some interplay thereof. Gender analysis, which aims to disaggregate social from biological differences between males and females, may help to elucidate these possible sources of effect modification.

DATA SOURCES AND DATA EXTRACTION

A PubMed literature search was performed in July 2009, using the terms "respiratory" and any of "sex" or "gender" or "men and women" or "boys and girls" and either "PM2.5" (particulate matter <or= 2.5 microm in aerodynamic diameter) or "NO2" (nitrogen dioxide). I reviewed the identified studies, and others cited therein, to summarize current evidence of effect modification, with attention to authors' interpretation of observed differences. Owing to broad differences in exposure mixes, outcomes, and analytic techniques, with few studies examining any given combination thereof, meta-analysis was not deemed appropriate at this time.

DATA SYNTHESIS

More studies of adults report stronger effects among women, particularly for older persons or where using residential exposure assessment. Studies of children suggest stronger effects among boys in early life and among girls in later childhood.

CONCLUSIONS

The qualitative review describes possible sources of difference in air pollution response between women and men, which may vary by life stage, coexposures, hormonal status, or other factors. The sources of observed effect modifications remain unclear, although gender analytic approaches may help to disentangle gender and sex differences in pollution response. A framework for incorporating gender analysis into environmental epidemiology is offered, along with several potentially useful methods from gender analysis.