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Zhu A, Cao Y, Li C, Yu J, Liu M, Xu K, Ruan Y. Effects of major air pollutants on angina hospitalizations: a correlation study. BMC Public Health 2024; 24:1877. [PMID: 39004712 PMCID: PMC11247793 DOI: 10.1186/s12889-024-19380-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Accepted: 07/05/2024] [Indexed: 07/16/2024] Open
Abstract
BACKGROUND Angina is a crucial risk signal for cardiovascular disease. However, few studies have evaluated the effects of ambient air pollution exposure on angina. OBJECTIVE We aimed to explore the short-term effects of air pollution on hospitalization for angina and its lag effects. METHODS We collected data on air pollutant concentrations and angina hospitalizations from 2013 to 2020. Distributed lag nonlinear model (DLNM) was used to evaluate the short-term effects of air pollutants on angina hospitalization under different lag structures. Stratified analysis by sex, age and season was obtained. RESULTS A total of 39,110 cases of angina hospitalization were included in the study. The results showed a significant positive correlation between PM2.5, SO2, NO2, and CO and angina hospitalization. Their maximum harmful effects were observed at lag0-7 (RR = 1.042; 95% CI: 1.017, 1.068), lag0-3 (RR = 1.067; 95% CI: 1.005, 1.133), lag0-6 (RR = 1.078; 95% CI: 1.041, 1.117), and lag0-6 (RR = 1.244; 95% CI: 1.109, 1.397), respectively. PM10 did not have an overall risk effect on angina hospitalization, but it did have a risk effect on women and the elderly. O3 was significantly negatively correlated with angina hospitalization, with the most pronounced effect observed at lag0-6 (RR = 0.960; 95% CI: 0.940, 0.982). Stratified analysis results showed that women and the elderly were more susceptible to pollutants, and the adverse effects of pollutants were stronger in the cold season. CONCLUSION Short-term exposure to PM2.5, SO2, NO2, and CO increases the risk of hospitalization for angina.
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Affiliation(s)
- Anning Zhu
- School of Public Health, Lanzhou University, Lanzhou, 730000, PR China
| | - Yongqin Cao
- Gansu Provincial Center for Disease Control and Prevention, Lanzhou, 730000, PR China
| | - Chunlan Li
- Third People's Hospital of Gansu Province, Lanzhou, 730000, PR China
| | - Jingze Yu
- School of Public Health, Lanzhou University, Lanzhou, 730000, PR China
| | - Miaoxin Liu
- School of Public Health, Lanzhou University, Lanzhou, 730000, PR China
| | - Ke Xu
- School of Public Health, Lanzhou University, Lanzhou, 730000, PR China
| | - Ye Ruan
- School of Public Health, Lanzhou University, Lanzhou, 730000, PR China.
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Agache I, Annesi-Maesano I, Cecchi L, Biagioni B, Chung KF, Clot B, D'Amato G, Damialis A, Del Giacco S, Dominguez-Ortega J, Galàn C, Gilles S, Holgate S, Jeebhay M, Kazadzis S, Nadeau K, Papadopoulos N, Quirce S, Sastre J, Tummon F, Traidl-Hoffmann C, Walusiak-Skorupa J, Jutel M, Akdis CA. EAACI guidelines on environmental science for allergy and asthma: The impact of short-term exposure to outdoor air pollutants on asthma-related outcomes and recommendations for mitigation measures. Allergy 2024; 79:1656-1686. [PMID: 38563695 DOI: 10.1111/all.16103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Revised: 03/08/2024] [Accepted: 03/10/2024] [Indexed: 04/04/2024]
Abstract
The EAACI Guidelines on the impact of short-term exposure to outdoor pollutants on asthma-related outcomes provide recommendations for prevention, patient care and mitigation in a framework supporting rational decisions for healthcare professionals and patients to individualize and improve asthma management and for policymakers and regulators as an evidence-informed reference to help setting legally binding standards and goals for outdoor air quality at international, national and local levels. The Guideline was developed using the GRADE approach and evaluated outdoor pollutants referenced in the current Air Quality Guideline of the World Health Organization as single or mixed pollutants and outdoor pesticides. Short-term exposure to all pollutants evaluated increases the risk of asthma-related adverse outcomes, especially hospital admissions and emergency department visits (moderate certainty of evidence at specific lag days). There is limited evidence for the impact of traffic-related air pollution and outdoor pesticides exposure as well as for the interventions to reduce emissions. Due to the quality of evidence, conditional recommendations were formulated for all pollutants and for the interventions reducing outdoor air pollution. Asthma management counselled by the current EAACI guidelines can improve asthma-related outcomes but global measures for clean air are needed to achieve significant impact.
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Affiliation(s)
- Ioana Agache
- Faculty of Medicine, Transylvania University, Brasov, Romania
| | - Isabella Annesi-Maesano
- Institute Desbrest of Epidemiology and Public Health, University of Montpellier and INSERM, Montpellier, France
| | - Lorenzo Cecchi
- Centre of Bioclimatology, University of Florence, Florence, Italy
| | - Benedetta Biagioni
- Allergy and Clinical Immunology Unit San Giovanni di Dio Hospital, Florence, Italy
| | - Kian Fan Chung
- National Hearth & Lung Institute, Imperial College London, London, UK
| | - Bernard Clot
- Federal office of meteorology and climatology MeteoSwiss, Payerne, Switzerland
| | - Gennaro D'Amato
- Respiratory Disease Department, Hospital Cardarelli, Naples, Italy
- University of Naples Federico II Medical School of Respiratory Diseases, Naples, Italy
| | - Athanasios Damialis
- Department of Ecology, School of Biology, Faculty of Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Stefano Del Giacco
- Department of Medical Sciences and Public Health, University of Cagliari, Monserrato, Italy
| | - Javier Dominguez-Ortega
- Department of Allergy, La Paz University Hospital, IdiPAZ, and CIBER of Respiratory Diseases (CIBERES), Madrid, Spain
| | - Carmen Galàn
- Inter-University Institute for Earth System Research (IISTA), International Campus of Excellence on Agrifood (ceiA3), University of Córdoba, Córdoba, Spain
| | - Stefanie Gilles
- Environmental Medicine, Faculty of Medicine, University of Augsburg, Augsburg, Germany
| | - Stephen Holgate
- Faculty of Medicine, University of Southampton, Southampton, UK
| | - Mohamed Jeebhay
- Occupational Medicine Division and Centre for Environmental & Occupational Health Research, University of Cape Town, Cape Town, South Africa
| | - Stelios Kazadzis
- Physikalisch-Meteorologisches Observatorium Davos, World Radiation Center, Davos, Switzerland
| | - Kari Nadeau
- John Rock Professor of Climate and Population Studies, Department of Environmental Health, Center for Climate, Health, and the Global Environment, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Nikolaos Papadopoulos
- Allergy and Clinical Immunology Unit, Second Pediatric Clinic, National and Kapodistrian University of Athens, Athens, Greece
- Division of Evolution and Genomic Sciences, University of Manchester, Manchester, UK
| | - Santiago Quirce
- Department of Allergy, La Paz University Hospital, IdiPAZ, and CIBER of Respiratory Diseases (CIBERES), Madrid, Spain
| | - Joaquin Sastre
- Allergy Service, Fundación Jiménez Díaz, Faculty of Medicine Universidad Autónoma de Madrid and CIBERES, Instituto Carlos III, Ministry of Science and Innovation, Madrid, Spain
| | - Fiona Tummon
- Respiratory Disease Department, Hospital Cardarelli, Naples, Italy
- University of Naples Federico II Medical School of Respiratory Diseases, Naples, Italy
| | - Claudia Traidl-Hoffmann
- Department of Environmental Medicine, Faculty of Medicine, University of Augsburg, Augsburg, Germany
- Institute of Environmental Medicine, Helmholtz Center Munich-German Research Center for Environmental Health, Augsburg, Germany
- Christine Kühne Center for Allergy Research and Education, Davos, Switzerland
| | - Jolanta Walusiak-Skorupa
- Department of Occupational Diseases and Environmental Health, Nofer Institute of Occupational Medicine, Lodz, Poland
| | - Marek Jutel
- Department of Clinical Immunology, Wrocław Medical University, and ALL-MED Medical Research Institute, Wroclaw, Poland
| | - Cezmi A Akdis
- Swiss Institute of Allergy and Asthma Research (SIAF), University Zurich, Davos, Switzerland
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Zarezadeh E, Jonidi Jafari A, Gholami M, Farzadkia M, Ashouri E, Shahsavani A, Kermani M, Nakhjirgan P. A comprehensive study on the spatial and temporal variation of BTEX and asbestos in the northwest of Iran: Human risk assessment. Heliyon 2024; 10:e31640. [PMID: 38845947 PMCID: PMC11153089 DOI: 10.1016/j.heliyon.2024.e31640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2024] [Revised: 05/09/2024] [Accepted: 05/20/2024] [Indexed: 06/09/2024] Open
Abstract
Substances like asbestos and other air pollutants, such as BTEX (benzene, toluene, ethylbenzene, and xylene), are hazardous compounds due to their adverse effects on human health. This study aims to investigate the levels, seasonal variations, spatial distribution, potential sources, and associated health risks associated with BTEX compounds and asbestos fibers in the ambient air of Tabriz. Air samples were taken at 16 different locations during the 2020-2021 period. Glass containers with charcoal were used for sample collection, and the BTEX content was determined using the GC-FID method. Phase-contrast microscopy (PCM) analysis was conducted with a low-volume peripheral pump for asbestos fiber sampling. The results showed that the average concentration of ∑BTEX was 37.94 and 27.98 μg/m3 in autumn and spring, respectively. The same parameter was 2.26 and 1.68 f/L for asbestos in the autumn and winter, respectively. The contribution of BTEX to ozone formation potential (OFP) in the research area showed that xylene and toluene were the major contributors to ozone production in different seasons. The risk of exposure to benzene compounds was 24 × 10-4 in children and 55.9 × 10-4 in adults, while the risk of exposure to ethylbenzene was 3.78 × 10-4 in children and 3.25 × 10-4 in adults. The estimated lifetime cancer risk was found to be the highest for benzene, followed by ethylbenzene. The estimated cancer risk for benzene and ethylbenzene exceeded the threshold values set by EPA, which signals a significant carcinogenic risk due to exposure to these substances in the ambient air of Tabriz. According to the EPA guidelines, the low carcinogenicity risk levels are between 10-4 and 10-6. According to the findings for the exposure to asbestos fibers, the maximum values of excess cancer risk (ECR) and estimated lifetime cancer risk (ELCR) were observed in the 16-30 age range across all locations, suggesting increased exposure to asbestos fibers compared to other age groups.
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Affiliation(s)
- Elnaz Zarezadeh
- Department of Environmental Health Engineering, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Ahmad Jonidi Jafari
- Department of Environmental Health Engineering, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
- Research Center for Environmental Health Technology, Iran University of Medical Sciences, Tehran, Iran
| | - Mitra Gholami
- Department of Environmental Health Engineering, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
- Research Center for Environmental Health Technology, Iran University of Medical Sciences, Tehran, Iran
| | - Mahdi Farzadkia
- Department of Environmental Health Engineering, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
- Research Center for Environmental Health Technology, Iran University of Medical Sciences, Tehran, Iran
| | - Ehsan Ashouri
- Department of Environmental Health Engineering, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Abbas Shahsavani
- Department of Environmental Health Engineering, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Air Quality and Climate Change Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Majid Kermani
- Department of Environmental Health Engineering, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
- Research Center for Environmental Health Technology, Iran University of Medical Sciences, Tehran, Iran
| | - Pegah Nakhjirgan
- Department of Environmental Health Engineering, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
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Yang H, Wang Z, Zhou Y, Gao Z, Xu J, Xiao S, Dai C, Wu F, Deng Z, Peng J, Ran P. Association between long-term ozone exposure and readmission for chronic obstructive pulmonary disease exacerbation. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2024; 348:123811. [PMID: 38531467 DOI: 10.1016/j.envpol.2024.123811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 03/14/2024] [Accepted: 03/15/2024] [Indexed: 03/28/2024]
Abstract
The relationship between long-term ozone (O₃) exposure and readmission for acute exacerbations of chronic obstructive pulmonary disease (AECOPD) remains elusive. In this study, we collected individual-level information on AECOPD hospitalizations from a standardized electronic database in Guangzhou from January 1, 2014, to December 31, 2015. We calculated the annual mean O₃ concentration prior to the dates of the index hospitalization for AECOPD using patients' residential addresses. Employing Cox proportional hazards models, we assessed the association between long-term O₃ concentration and the risk of AECOPD readmission across several time frames (30 days, 90 days, 180 days, and 365 days). We estimated the disease and economic burden of AECOPD readmissions attributable to O₃ using a counterfactual approach. Of the 4574 patients included in the study, 1398 (30.6%) were readmitted during the study period, with 262 (5.7%) readmitted within 30 days. The annual mean O₃ concentration was 90.3 μg/m3 (standard deviation [SD] = 8.2 μg/m3). A 10-μg/m3 increase in long-term O₃ concentration resulted in a hazard ratio (HR) for AECOPD readmission within 30 days of 1.28 (95% confidence interval [CI], 1.09 to 1.49), with similar results for readmission within 90, 180, and 365 days. Older patients (aged 75 years or above) and males were more susceptible (HR, 1.33; 95% CI, 1.10-1.61 and HR, 1.29; 95% CI, 1.09-1.53, respectively). The population attributable fraction for 30-day readmission due to O₃ exposure was 29.0% (95% CI, 28.4%-30.0%), and the attributable mean cost per participant was 362.3 USD (354.5-370.2). Long-term exposure to elevated O₃ concentrations is associated with an increased risk of AECOPD readmission, contributing to a significant disease and economic burden.
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Affiliation(s)
- Huajing Yang
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, Postcode, China; Guangzhou National Laboratory, Guangzhou, Guangdong, Postcode, China
| | - Zihui Wang
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, Postcode, China
| | - Yumin Zhou
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, Postcode, China; Guangzhou National Laboratory, Guangzhou, Guangdong, Postcode, China
| | - Zhaosheng Gao
- Guangzhou Health Technology Appraisal and Talent Evaluation Center, Guangzhou Municipal Health Commission, Guangzhou, China
| | - Jing Xu
- Guangzhou Health Technology Appraisal and Talent Evaluation Center, Guangzhou Municipal Health Commission, Guangzhou, China
| | - Shan Xiao
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, Postcode, China; Department of Pulmonary and Critical Care Medicine, Shenzhen Longgang District Central Hospital, Shenzhen, China
| | - Cuiqiong Dai
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, Postcode, China
| | - Fan Wu
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, Postcode, China; Guangzhou National Laboratory, Guangzhou, Guangdong, Postcode, China
| | - Zhishan Deng
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, Postcode, China
| | - Jieqi Peng
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, Postcode, China; Guangzhou National Laboratory, Guangzhou, Guangdong, Postcode, China
| | - Pixin Ran
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, Postcode, China; Guangzhou National Laboratory, Guangzhou, Guangdong, Postcode, China.
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5
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McCarron A, Semple S, Swanson V, Gillespie C, Braban C, Price HD. Piloting co-developed behaviour change interventions to reduce exposure to air pollution and improve self-reported asthma-related health. JOURNAL OF EXPOSURE SCIENCE & ENVIRONMENTAL EPIDEMIOLOGY 2024:10.1038/s41370-024-00661-2. [PMID: 38609513 DOI: 10.1038/s41370-024-00661-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 03/05/2024] [Accepted: 03/07/2024] [Indexed: 04/14/2024]
Abstract
BACKGROUND Exposure to air pollution can exacerbate asthma with immediate and long-term health consequences. Behaviour changes can reduce exposure to air pollution, yet its 'invisible' nature often leaves individuals unaware of their exposure, complicating the identification of appropriate behaviour modifications. Moreover, making health behaviour changes can be challenging, necessitating additional support from healthcare professionals. OBJECTIVE This pilot study used personal exposure monitoring, data feedback, and co-developed behaviour change interventions with individuals with asthma, with the goal of reducing personal exposure to PM2.5 and subsequently improving asthma-related health. METHODS Twenty-eight participants conducted baseline exposure monitoring for one-week, simultaneously keeping asthma symptom and medication diaries (previously published in McCarron et al., 2023). Participants were then randomised into control (n = 8) or intervention (n = 9) groups. Intervention participants received PM2.5 exposure feedback and worked with researchers to co-develop behaviour change interventions based on a health behaviour change programme which they implemented during the follow-up monitoring week. Control group participants received no feedback or intervention during the study. RESULTS All interventions focused on the home environment. Intervention group participants reduced their at-home exposure by an average of 5.7 µg/m³ over the monitoring week (-23.0 to +3.2 µg/m³), whereas the control group had a reduction of 4.7 µg/m³ (-15.6 to +0.4 µg/m³). Furthermore, intervention group participants experienced a 4.6% decrease in participant-hours with reported asthma symptoms, while the control group saw a 0.5% increase. Similarly, the intervention group's asthma-related quality of life improved compared to the control group. IMPACT STATEMENT This pilot study investigated a novel behaviour change intervention, utilising personal exposure monitoring, data feedback, and co-developed interventions guided by a health behaviour change programme. The study aimed to reduce personal exposure to fine particulate matter (PM2.5) and improve self-reported asthma-related health. Conducting a randomised controlled trial with 28 participants, co-developed intervention successfully targeted exposure peaks within participants' home microenvironments, resulting in a reduction in at-home personal exposure to PM2.5 and improving self-reported asthma-related health. The study contributes valuable insights into the environmental exposure-health relationship and highlights the potential of the intervention for individual-level decision-making to protect human health.
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Affiliation(s)
- Amy McCarron
- Biological and Environmental Sciences, University of Stirling, Stirling, UK.
| | - Sean Semple
- Institute of Social Marketing and Health, University of Stirling, Stirling, UK
| | | | | | | | - Heather D Price
- Biological and Environmental Sciences, University of Stirling, Stirling, UK
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Sparks MS, Farahbakhsh I, Anand M, Bauch CT, Conlon KC, East JD, Li T, Lickley M, Garcia-Menendez F, Monier E, Saari RK. Health and equity implications of individual adaptation to air pollution in a changing climate. Proc Natl Acad Sci U S A 2024; 121:e2215685121. [PMID: 38227646 PMCID: PMC10835109 DOI: 10.1073/pnas.2215685121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 11/05/2023] [Indexed: 01/18/2024] Open
Abstract
Future climate change can cause more days with poor air quality. This could trigger more alerts telling people to stay inside to protect themselves, with potential consequences for health and health equity. Here, we study the change in US air quality alerts over this century due to fine particulate matter (PM2.5), who they may affect, and how they may respond. We find air quality alerts increase by over 1 mo per year in the eastern United States by 2100 and quadruple on average. They predominantly affect areas with high Black populations and leakier homes, exacerbating existing inequalities and impacting those less able to adapt. Reducing emissions can offer significant annual health benefits ($5,400 per person) by mitigating the effect of climate change on air pollution and its associated risks of early death. Relying on people to adapt, instead, would require them to stay inside, with doors and windows closed, for an extra 142 d per year, at an average cost of $11,000 per person. It appears likelier, however, that people will achieve minimal protection without policy to increase adaptation rates. Boosting adaptation can offer net benefits, even alongside deep emission cuts. New adaptation policies could, for example: reduce adaptation costs; reduce infiltration and improve indoor air quality; increase awareness of alerts and adaptation; and provide measures for those working or living outdoors. Reducing emissions, conversely, lowers everyone's need to adapt, and protects those who cannot adapt. Equitably protecting human health from air pollution under climate change requires both mitigation and adaptation.
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Affiliation(s)
- Matt S. Sparks
- Department of Civil and Environmental Engineering, University of Waterloo, Waterloo, ONN2L 3G1, Canada
| | - Isaiah Farahbakhsh
- School of Environmental Sciences, University of Guelph, Waterloo, ONN1G 2W1, Canada
| | - Madhur Anand
- School of Environmental Sciences, University of Guelph, Waterloo, ONN1G 2W1, Canada
| | - Chris T. Bauch
- Department of Applied Mathematics, University of Waterloo, Waterloo, ONN2L 3G, Canada
| | - Kathryn C. Conlon
- School of Medicine, Department of Public Health Sciences, University of California, Davis, CA95616
- School of Veterinary Medicine, Department of Medicine and Epidemiology, University of California, Davis, CA95616
| | - James D. East
- Department of Civil, Construction, and Environmental Engineering, North Carolina State University, Raleigh, NC27695
| | - Tianyuan Li
- Department of Civil and Environmental Engineering, University of Waterloo, Waterloo, ONN2L 3G1, Canada
| | - Megan Lickley
- Department of Earth, Atmospheric, and Planetary Sciences, Massachusetts Institute of Technology, Cambridge, MA02139N
| | - Fernando Garcia-Menendez
- Department of Civil, Construction, and Environmental Engineering, North Carolina State University, Raleigh, NC27695
| | - Erwan Monier
- Department of Land, Air and Water Resources, University of California, Davis, CA95616
| | - Rebecca K. Saari
- Department of Civil and Environmental Engineering, University of Waterloo, Waterloo, ONN2L 3G1, Canada
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Tan T, Junghans C, Varaden D. Empowering community health professionals for effective air pollution information communication. BMC Public Health 2023; 23:2547. [PMID: 38124041 PMCID: PMC10734129 DOI: 10.1186/s12889-023-17462-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 12/12/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Air pollution remains a significant public health risk, particularly in urban areas. Effective communication strategies remain integral to overall protection by encouraging the adoption of personal air pollution exposure reduction behaviours. This study aims to explore how community health professionals can be empowered to communicate air pollution information and advice to the wider community, to encourage the uptake of desired behaviours in the population. METHODS The study adopted a qualitative methodology, where four homogenous Focus Group Discussions (FGDs) were held with a range of community health professionals, including Health Care Professionals, Community Health and Wellbeing Workers (CHWWs) and Social Prescribing Link Workers (SPLW). A classical content analysis was conducted with the Structural Empowerment Theory (SET) and Psychological Empowerment Theory (PET) as guiding concepts. RESULTS Five key themes were identified: from a structural empowerment perspective: [1] resources and support, [2] knowledge. From a psychological empowerment perspective: [3] confidence as advisor, [4] responsibility as advisor, and [5] residents' receptiveness to advice. It was concluded that advice should be risk stratified, clear, easy to follow and provide alternatives. CONCLUSION This study identified ways for community health professionals to be empowered by local councils or other organisations in providing advice on air pollution, through the provision of essential structural support and opportunities to enhance their knowledge and confidence in the subject. Implementing recommendations from this study would not only empower community health professionals to advise on air pollution to the wider community but also increase adherence to health advice.
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Affiliation(s)
- Tricia Tan
- School of Public Health, Imperial College London, London, UK
| | - Cornelia Junghans
- Department of Primary Care and Public Health, Imperial College London, London, UK
| | - Diana Varaden
- MRC Centre for Environment and Health, Imperial College London, London, UK.
- NIHR-HPRU Environmental Exposures and Health, School of Public Health, Imperial College London, London, UK.
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Ren J, Yin B, Guo Z, Sun X, Pei H, Wen R, Wang Z, Zhu S, Zuo J, Zhang Y, Ma Y. Astaxanthin alleviates PM 2.5-induced cardiomyocyte injury via inhibiting ferroptosis. Cell Mol Biol Lett 2023; 28:95. [PMID: 38007415 PMCID: PMC10675963 DOI: 10.1186/s11658-023-00513-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 11/14/2023] [Indexed: 11/27/2023] Open
Abstract
BACKGROUND Long-term exposure of humans to air pollution is associated with an increasing risk of cardiovascular diseases (CVDs). Astaxanthin (AST), a naturally occurring red carotenoid pigment, was proved to have multiple health benefits. However, whether or not AST also exerts a protective effect on fine particulate matter (PM2.5)-induced cardiomyocyte damage and its underlying mechanisms remain unclear. METHODS In vitro experiments, the H9C2 cells were subjected to pretreatment with varying concentrations of AST, and then cardiomyocyte injury model induced by PM2.5 was established. The cell viability and the ferroptosis-related proteins expression were measured in different groups. In vivo experiments, the rats were pretreated with different concentrations of AST for 21 days. Subsequently, a rat model of myocardial PM2.5 injury was established by intratracheal instillation every other day for 1 week. The effects of AST on myocardial tissue injury caused by PM2.5 indicating by histological, serum, and protein analyses were examined. RESULTS AST significantly ameliorated PM2.5-induced myocardial tissue injury, inflammatory cell infiltration, the release of inflammatory factors, and cardiomyocyte H9C2 cell damage. Mechanistically, AST pretreatment increased the expression of SLC7A11, GPX4 and down-regulated the expression of TfR1, FTL and FTH1 in vitro and in vivo. CONCLUSIONS Our study suggest that ferroptosis plays a significant role in the pathogenesis of cardiomyocyte injury induced by PM2.5. AST may serve as a potential therapeutic agent for mitigating cardiomyocyte injury caused by PM2.5 through the inhibition of ferroptosis.
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Affiliation(s)
- Jingyi Ren
- Department of Nutrition and Food Hygiene, School of Public Health, Hebei Key Laboratory of Environment and Human Health, Hebei Medical University, Shijiazhuang, 050017, China
| | - Bowen Yin
- Department of Nutrition and Food Hygiene, School of Public Health, Hebei Key Laboratory of Environment and Human Health, Hebei Medical University, Shijiazhuang, 050017, China
| | - Zihao Guo
- Undergraduate of College of Public Health, Hebei Medical University, Shijiazhuang, 050017, China
| | - Xiaoya Sun
- Department of Nutrition and Food Hygiene, School of Public Health, Hebei Key Laboratory of Environment and Human Health, Hebei Medical University, Shijiazhuang, 050017, China
| | - Huanting Pei
- Department of Nutrition and Food Hygiene, School of Public Health, Hebei Key Laboratory of Environment and Human Health, Hebei Medical University, Shijiazhuang, 050017, China
| | - Rui Wen
- Department of Nutrition and Food Hygiene, School of Public Health, Hebei Key Laboratory of Environment and Human Health, Hebei Medical University, Shijiazhuang, 050017, China
| | - Ziyi Wang
- Undergraduate of College of Public Health, Hebei Medical University, Shijiazhuang, 050017, China
| | - Siqi Zhu
- Department of Nutrition and Food Hygiene, School of Public Health, Hebei Key Laboratory of Environment and Human Health, Hebei Medical University, Shijiazhuang, 050017, China
| | - Jinshi Zuo
- Department of Nutrition and Food Hygiene, School of Public Health, Hebei Key Laboratory of Environment and Human Health, Hebei Medical University, Shijiazhuang, 050017, China
| | - Yadong Zhang
- Department of Nutrition and Food Hygiene, School of Public Health, Hebei Key Laboratory of Environment and Human Health, Hebei Medical University, Shijiazhuang, 050017, China
| | - Yuxia Ma
- Department of Nutrition and Food Hygiene, School of Public Health, Hebei Key Laboratory of Environment and Human Health, Hebei Medical University, Shijiazhuang, 050017, China.
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9
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Zhao T, Markevych I, Fuertes E, de Hoogh K, Accordini S, Boudier A, Casas L, Forsberg B, Garcia Aymerich J, Gnesi M, Holm M, Janson C, Jarvis D, Johannessen A, Jörres RA, Karrasch S, Leynaert B, Maldonado Perez JA, Malinovschi A, Martínez-Moratalla J, Modig L, Nowak D, Potts J, Probst-Hensch N, Sánchez-Ramos JL, Siroux V, Urrutia Landa I, Vienneau D, Villani S, Jacquemin B, Heinrich J. Impact of long-term exposure to ambient ozone on lung function over a course of 20 years (The ECRHS study): a prospective cohort study in adults. THE LANCET REGIONAL HEALTH. EUROPE 2023; 34:100729. [PMID: 37691742 PMCID: PMC10482740 DOI: 10.1016/j.lanepe.2023.100729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 08/17/2023] [Accepted: 08/21/2023] [Indexed: 09/12/2023]
Abstract
Background While the adverse effects of short-term ambient ozone exposure on lung function are well-documented, the impact of long-term exposure remains poorly understood, especially in adults. Methods We aimed to investigate the association between long-term ozone exposure and lung function decline. The 3014 participants were drawn from 17 centers across eight countries, all of which were from the European Community Respiratory Health Survey (ECRHS). Spirometry was conducted to measure pre-bronchodilation forced expiratory volume in 1 s (FEV1) and forced vital capacity (FVC) at approximately 35, 44, and 55 years of age. We assigned annual mean values of daily maximum running 8-h average ozone concentrations to individual residential addresses. Adjustments were made for PM2.5, NO2, and greenness. To capture the ozone-related change in spirometric parameters, our linear mixed effects regression models included an interaction term between long-term ozone exposure and age. Findings Mean ambient ozone concentrations were approximately 65 μg/m³. A one interquartile range increase of 7 μg/m³ in ozone was associated with a faster decline in FEV1 of -2.08 mL/year (95% confidence interval: -2.79, -1.36) and in FVC of -2.86 mL/year (-3.73, -1.99) mL/year over the study period. Associations were robust after adjusting for PM2.5, NO2, and greenness. The associations were more pronounced in residents of northern Europe and individuals who were older at baseline. No consistent associations were detected with the FEV1/FVC ratio. Interpretation Long-term exposure to elevated ambient ozone concentrations was associated with a faster decline of spirometric lung function among middle-aged European adults over a 20-year period. Funding German Research Foundation.
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Affiliation(s)
- Tianyu Zhao
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Munich, Germany
- Comprehensive Pneumology Center Munich (CPC-M), German Center for Lung Research (DZL), Munich, Germany
- Institute of Epidemiology, Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, Germany
| | - Iana Markevych
- Institute of Psychology, Jagiellonian University, Krakow, Poland
- “Health and Quality of Life in a Green and Sustainable Environment”, SRIPD, Medical University of Plovdiv, Plovdiv, Bulgaria
| | - Elaine Fuertes
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
- MRC Centre for Environment & Health, London, UK
| | - Kees de Hoogh
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
| | - Simone Accordini
- Unit of Epidemiology and Medical Statistics, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Anne Boudier
- University Grenoble Alpes, Inserm U 1209, CNRS UMR 5309, Team of Environmental Epidemiology Applied to the Development and Respiratory Health, Institute for Advanced Biosciences, Grenoble, France
- Pediatric Department, CHU Grenoble Alpes, Grenoble, France
| | - Lidia Casas
- Social Epidemiology and Health Policy, Department of Family Medicine and Population Health, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
- Institute for Environment and Sustainable Development (IMDO), University of Antwerp, Belgium
| | - Bertil Forsberg
- Section of Sustainable Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Judith Garcia Aymerich
- ISGlobal, Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Marco Gnesi
- Unit of Biostatistics and Clinical Epidemiology, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy
| | - Mathias Holm
- Occupational and Environmental Medicine, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Christer Janson
- Department of Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
| | - Deborah Jarvis
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
- MRC Centre for Environment & Health, London, UK
| | - Ane Johannessen
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Rudolf A. Jörres
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Munich, Germany
- Comprehensive Pneumology Center Munich (CPC-M), German Center for Lung Research (DZL), Munich, Germany
| | - Stefan Karrasch
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Munich, Germany
- Comprehensive Pneumology Center Munich (CPC-M), German Center for Lung Research (DZL), Munich, Germany
- Institute of Epidemiology, Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, Germany
| | - Benedicte Leynaert
- Université Paris-Saclay, UVSQ, University Paris-Sud, Inserm, Center for Epidemiology and Population Health (CESP) - Integrative Respiratory Epidemiology Team, 94807, Villejuif, France
| | | | - Andrei Malinovschi
- Department of Medical Sciences, Clinical Physiology, Uppsala University, Uppsala, Sweden
| | | | - Lars Modig
- Section of Sustainable Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Dennis Nowak
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Munich, Germany
- Comprehensive Pneumology Center Munich (CPC-M), German Center for Lung Research (DZL), Munich, Germany
| | - James Potts
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Nicole Probst-Hensch
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
| | | | - Valerie Siroux
- University Grenoble Alpes, Inserm U 1209, CNRS UMR 5309, Team of Environmental Epidemiology Applied to the Development and Respiratory Health, Institute for Advanced Biosciences, Grenoble, France
| | | | - Danielle Vienneau
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
| | - Simona Villani
- Unit of Biostatistics and Clinical Epidemiology, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy
| | - Bénédicte Jacquemin
- University Rennes, Inserm, EHESP, Irset (Institut de recherche en Santé, Environnement et travail), UMR_S 1085, F-35000 Rennes, France
| | - Joachim Heinrich
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Munich, Germany
- Comprehensive Pneumology Center Munich (CPC-M), German Center for Lung Research (DZL), Munich, Germany
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
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10
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Blanco E, Algranti E, Cifuentes LA, López-Carrillo L, Mora AM, Rodríguez-Guzmán J, Rodríguez-Villamizar LA, Veiga LHS, Canelo-Aybar C, Nieto-Gutierrez W, Feliu A, Espina C, Ferreccio C. Latin America and the Caribbean Code Against cancer 1st edition: Environment, occupation, and cancer. Cancer Epidemiol 2023; 86 Suppl 1:102381. [PMID: 37852723 DOI: 10.1016/j.canep.2023.102381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 03/21/2023] [Accepted: 03/25/2023] [Indexed: 10/20/2023]
Abstract
Within the framework of the Latin America and Caribbean region (LAC) Code Against Cancer 1st edition, the current work presents recommendations to reduce exposure to environmental and occupational carcinogenic agents relevant for LAC. Using the methodology established by the International Agency for Research on Cancer (IARC) in the World Code Against Cancer Framework and experience from developing the European Code Against Cancer 4th edition, a working group of LAC cancer-prevention experts reviewed the list of Group I IARC carcinogenic agents, identified prevalent environmental and occupational exposures in the region, and proposed evidence-based cancer prevention recommendations suited to the epidemiological, socioeconomic, and cultural conditions of LAC countries. Two sets of recommendations were drafted: those targeting the general public and a second set for policymakers. Outdoor and indoor air pollution, ultra-violet radiation and occupational exposures to silica dust, asbestos, benzene, diesel, and welding fumes were identified as prevalent carcinogens in LAC and as agents that could be reduced or eliminated to prevent cancers. Recommendations for additional risk factors were not included due to insufficient data of their attributable burden in LAC (sunbeds, radon, aflatoxin), or lack of a clear preventive action to be taken by the individual (arsenic in drinking water, medical radiation), or lack of evidence of carcinogenicity effect (bisphenol A, phthalates, and pesticides). A broad consensus was reached on environmental and occupational carcinogenic exposures present throughout the LAC region and on individual-level and public policy-level recommendations to reduce or eliminate these exposures. Key educational content for the dissemination of these recommendations was also developed as part of LAC Code Against Cancer 1st Edition.
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Affiliation(s)
- Estela Blanco
- Centro de Investigación en Sociedad y Salud y Nucleo Milenio SocioMed, Universidad Mayor, Badajoz 130, Oficina 1305, Las Condes, Santiago 7550000, Chile; Departamento de Salud Pública, Facultad de Medicina, Pontificia Universidad Católica de Chile, Avenida Libertador Bernardo O'Higgins 340, Región Metropolitana, Postal/Zip Code: 8331150, Santiago, Chile
| | | | - Luis Abdon Cifuentes
- Departamento de Ingeniería, Pontificia Universidad Católica de Chile, Avenida Libertador Bernardo O'Higgins 340, Región Metropolitana, Postal/Zip Code: 8331150, Santiago, Chile
| | - Lizbeth López-Carrillo
- Instituto Nacional de Salud Pública, Avenida Universidad 655, Santa María Ahuacatitlán, Cuernavaca, Morelos 62100, Mexico
| | - Ana M Mora
- Center for Environmental Research and Community Health (CERCH), School of Public Health, University of California, 1995 University Avenue, Suite 265, Berkeley, CA 94720-7392, USA
| | | | - Laura Andrea Rodríguez-Villamizar
- Escuela de Medicina, Facultad de Salud, Universidad Industrial de Santander, Cra. 32 #29-31, Bucaramanga, Santander 680002, Colombia
| | - Lene H S Veiga
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, 9609 Medical Center Drive, MSC 9776, Bethesda 20892, MD, USA
| | - Carlos Canelo-Aybar
- Department of Clinical Epidemiology and Public Health, Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
| | - Wendy Nieto-Gutierrez
- Department of Clinical Epidemiology and Public Health, Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
| | - Ariadna Feliu
- International Agency for Research on Cancer (IARC/WHO), Environment and Lifestyle Epidemiology Branch, 25 avenue Tony Garnier CS 90627, CEDEX 0769366, Lyon, France
| | - Carolina Espina
- International Agency for Research on Cancer (IARC/WHO), Environment and Lifestyle Epidemiology Branch, 25 avenue Tony Garnier CS 90627, CEDEX 0769366, Lyon, France
| | - Catterina Ferreccio
- Departamento de Salud Pública, Facultad de Medicina, Pontificia Universidad Católica de Chile, Avenida Libertador Bernardo O'Higgins 340, Región Metropolitana, Postal/Zip Code: 8331150, Santiago, Chile; Advanced Center for Chronic Diseases ACCDIS, Santiago, Chile.
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11
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Berg CD, Schiller JH, Boffetta P, Cai J, Connolly C, Kerpel-Fronius A, Kitts AB, Lam DCL, Mohan A, Myers R, Suri T, Tammemagi MC, Yang D, Lam S. Air Pollution and Lung Cancer: A Review by International Association for the Study of Lung Cancer Early Detection and Screening Committee. J Thorac Oncol 2023; 18:1277-1289. [PMID: 37277094 DOI: 10.1016/j.jtho.2023.05.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 05/26/2023] [Indexed: 06/07/2023]
Abstract
INTRODUCTION The second leading cause of lung cancer is air pollution. Air pollution and smoking are synergistic. Air pollution can worsen lung cancer survival. METHODS The Early Detection and Screening Committee of the International Association for the Study of Lung Cancer formed a working group to better understand issues in air pollution and lung cancer. These included identification of air pollutants, their measurement, and proposed mechanisms of carcinogenesis. The burden of disease and the underlying epidemiologic evidence linking air pollution to lung cancer in individuals who never and ever smoked were summarized to quantify the problem, assess risk prediction models, and develop recommended actions. RESULTS The number of estimated attributable lung cancer deaths has increased by nearly 30% since 2007 as smoking has decreased and air pollution has increased. In 2013, the International Agency for Research on Cancer classified outdoor air pollution and particulate matter with aerodynamic diameter less than 2.5 microns in outdoor air pollution as carcinogenic to humans (International Agency for Research on Cancer group 1) and as a cause of lung cancer. Lung cancer risk models reviewed do not include air pollution. Estimation of cumulative exposure to air pollution exposure is complex which poses major challenges with accurately collecting long-term exposure to ambient air pollution for incorporation into risk prediction models in clinical practice. CONCLUSIONS Worldwide air pollution levels vary widely, and the exposed populations also differ. Advocacy to lower sources of exposure is important. Health care can lower its environmental footprint, becoming more sustainable and resilient. The International Association for the Study of Lung Cancer community can engage broadly on this topic.
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Affiliation(s)
| | - Joan H Schiller
- Department of Medicine, University of Virginia, Charlottesville, Virginia
| | - Paolo Boffetta
- Stony Brook Cancer Center, Stony Brook University, Stony Brook, New York
| | - Jing Cai
- School of Public Health, Key Lab of Public Health Safety of the Ministry of Education and National Health Commission Key Lab of Health Technology Assessment, Fudan University, Shanghai, People's Republic of China
| | - Casey Connolly
- The International Association for the Study of Lung Cancer, Denver, Colorado
| | - Anna Kerpel-Fronius
- Department of Radiology National Korányi Institute for Pulmonology, Budapest, Hungary
| | | | - David C L Lam
- University Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong SAR, People's Republic of China
| | - Anant Mohan
- Department of Pulmonary Medicine, Critical Care, and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Renelle Myers
- Department of Integrative Oncology, British Columbia Cancer Research Institute, Vancouver, British Columbia, Canada
| | - Tejas Suri
- Department of Pulmonary Medicine, Critical Care, and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Martin C Tammemagi
- Department of Health Sciences, Brock University, St. Catharines, Ontario, Canada
| | - Dawei Yang
- Department of Pulmonary Medicine and Critical Care, Zhongshan Hospital Fudan University, Shanghai, People's Republic of China
| | - Stephen Lam
- Department of Medicine, British Columbia Cancer Agency and The University of British Columbia, Vancouver, British Columbia, Canada
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12
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Brigham E, Hashimoto A, Alexis NE. Air Pollution and Diet: Potential Interacting Exposures in Asthma. Curr Allergy Asthma Rep 2023; 23:541-553. [PMID: 37440094 DOI: 10.1007/s11882-023-01101-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/17/2023] [Indexed: 07/14/2023]
Abstract
PURPOSE OF REVIEW To provide a review of emerging literature describing the impact of diet on the respiratory response to air pollution in asthma. RECENT FINDINGS Asthma phenotyping (observable characteristics) and endotyping (mechanistic pathways) have increased the specificity of diagnostic and treatment pathways and opened the doors to the identification of subphenotypes with enhanced susceptibility to exposures and interventions. Mechanisms underlying the airway immune response to air pollution are still being defined but include oxidative stress, inflammation, and activation of adaptive and innate immune responses, with genetic susceptibility highlighted. Of these, neutrophil recruitment and activation appear prominent; however, understanding neutrophil function in response to pollutant exposures is a research gap. Diet may play a role in asthma pathogenesis and morbidity; therefore, diet modification is a potential target opportunity to protect against pollutant-induced lung injury. In particular, in vivo and in vitro data suggest the potential for diet to modify the inflammatory response in the airways, including impacts on neutrophil recruitment and function. Murine models provide compelling results in regard to the potential for dietary components (including fiber, antioxidants, and omega-3 fatty acids) to buffer against the inflammatory response to air pollution in the lung. Precision lifestyle approaches to asthma management and respiratory protection in the context of air pollution exposures may evolve to include diet, pending the results of further epidemiologic and causal investigation and with neutrophil recruitment and activation as a candidate mechanism.
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Affiliation(s)
- Emily Brigham
- Division of Respirology, University of British Columbia, Vancouver, BC, Canada.
- Vancouver Coastal Health Research Institute, Vancouver, BC, Canada.
| | - Alisa Hashimoto
- Faculty of Science, University of British Columbia, BC, Vancouver, Canada
| | - Neil E Alexis
- Center for Environmental Medicine, Asthma and Lung Biology, University of North Carolina School of Medicine, Chapel Hill, NC, USA
- Department of Pediatrics, Division of Allergy, Immunology, Rheumatology and Infectious Disease, University of North Carolina School of Medicine, Chapel Hill, NC, USA
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13
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Kalisa E, Clark ML, Ntakirutimana T, Amani M, Volckens J. Exposure to indoor and outdoor air pollution in schools in Africa: Current status, knowledge gaps, and a call to action. Heliyon 2023; 9:e18450. [PMID: 37560671 PMCID: PMC10407038 DOI: 10.1016/j.heliyon.2023.e18450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 07/04/2023] [Accepted: 07/18/2023] [Indexed: 08/11/2023] Open
Abstract
Chronic exposure to indoor and outdoor air pollution is linked to adverse human health impacts worldwide, and in children, these include increased respiratory symptoms, reduced cognitive and academic performance, and absences from school. African children are exposed to high levels of air pollution from aging diesel and gasoline second-hand vehicles, dusty roads, trash burning, and solid-fuel combustion for cooking. There is a need for more empirical evidence on the impact of air pollutants on schoolchildren in most countries of Africa. Therefore, we conducted a scoping review on schoolchildren's exposure to indoor and outdoor PM2.5 (particulate matter with an aerodynamic diameter less than 2.5 μm and PM10 (particulate matter with an aerodynamic diameter less than 10 μm) in Africa. Following PRISMA guidelines, our search strategy yielded 2975 records, of which eight peer-reviewed articles met our selection criteria and were considered in the final analysis. We also analyzed satellite data on PM2.5 and PM10 levels in five African regions from 1990 to 2019 and compared schoolchildren's exposure to PM2.5 and PM10 levels in Africa with available data from the rest of the world. The findings showed that schoolchildren in Africa are frequently exposed to PM2.5 and PM10 levels exceeding the recommended World Health Organization air quality guidelines. We conclude with a list of recommendations and strategies to reduce air pollution exposure in African schools. Education can help to produce citizens who are literate in environmental science and policy. More air quality measurements in schools and intervention studies are needed to protect schoolchildren's health and reduce exposure to air pollution in classrooms across Africa.
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Affiliation(s)
- Egide Kalisa
- College of Science and Technology, Center of Excellence in Biodiversity and Natural Resource Management, University of Rwanda, Kigali, P.O BOX, 4285, Kigali, Rwanda
- Air Quality Processes Research Section, Environment and Climate Change Canada, 4905 Dufferin Street, Toronto, M3H5T4, Canada
| | - Maggie L. Clark
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, CO, USA
| | - Theoneste Ntakirutimana
- University of Rwanda, School of Public Health, College of Medicine and Health Sciences, Kigali, P.O BOX, 4285, Kigali, Rwanda
| | - Mabano Amani
- Departament de Biologia Evolutiva, Ecologia i Ciències Ambientals (BEECA), Universitat de Barcelona (UB), Av. Diagonal 643, 08028, Barcelona, Spain
| | - John Volckens
- Department of Mechanical Engineering, Colorado State University, Fort Collins, CO, 80523, USA
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14
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Rosser FJ, Rothenberger SD, Han YY, Forno E, Celedón JC. Air Quality Index and Childhood Asthma: A Pilot Randomized Clinical Trial Intervention. Am J Prev Med 2023; 64:893-897. [PMID: 36642643 PMCID: PMC10200724 DOI: 10.1016/j.amepre.2022.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 12/20/2022] [Accepted: 12/20/2022] [Indexed: 01/15/2023]
Abstract
INTRODUCTION To reduce air pollution exposure, the U.S. asthma guidelines recommend that children check the Air Quality Index before outdoor activity. Whether adding the Air Quality Index and recommendations to asthma action plans reduces exacerbations and improves control and quality of life in children with asthma is unknown. METHODS A pilot, unblinded, randomized clinical trial of 40 children with persistent asthma, stratified by age and randomized 1:1, recruited from the University of Pittsburgh Medical Center Children's Hospital of Pittsburgh (Pittsburgh, PA) was conducted. All participants received asthma action plans and Air Quality Index education. The intervention group received printed Air Quality Index information and showed the ability to use AirNow. Asthma exacerbations were assessed through a questionnaire, asthma control was assessed with the Asthma Control Test and Childhood Asthma Control Test, and quality of life was assessed with the Pediatric Asthma Quality of Life Questionnaire. After randomization (July-October 2020), participants were followed monthly for 6 months (exit January-March 2021). Outcome differences between groups were evaluated at the exit visit and over time (analysis was in 2021). RESULTS At randomization, there were no significant differences in age, sex, race, or asthma severity. At exit, more intervention participants checked the Air Quality Index (63% vs 15%) with no differences in the proportion of asthma exacerbations or mean Childhood Asthma Control Test or Pediatric Asthma Quality of Life Questionnaire scores. The mean change in Asthma Control Test score was higher in the intervention group (change in Asthma Control Test=2.00 vs 0.15 for the control), which was modified by time (β=1.85, CI=0.09, 3.61). Physical activity was decreased overall and showed modification by treatment and time. CONCLUSIONS Addition of the Air Quality Index to asthma action plans led to improved asthma control by Asthma Control Test scores but may decrease outdoor activity.
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Affiliation(s)
- Franziska J Rosser
- Division of Pulmonary Medicine, Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, Pennsylvania.
| | - Scott D Rothenberger
- Division of General Internal Medicine, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Yueh-Ying Han
- Division of Pulmonary Medicine, Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Erick Forno
- Division of Pulmonary Medicine, Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Juan C Celedón
- Division of Pulmonary Medicine, Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, Pennsylvania
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15
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Rosser F, Balmes J. Ozone and childhood respiratory health: A primer for US pediatric providers and a call for a more protective standard. Pediatr Pulmonol 2023; 58:1355-1366. [PMID: 36815617 PMCID: PMC10121852 DOI: 10.1002/ppul.26368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 01/30/2023] [Accepted: 02/17/2023] [Indexed: 02/24/2023]
Abstract
Ground level ozone is a potent respiratory toxicant with decades of accumulated data demonstrating respiratory harms to children. Despite the ubiquity of ozone in the United States, impacting both urban and rural communities, the associated harms of exposure to this important air pollutant are often infrequently or inadequately covered during medical training including pulmonary specialization. Thus, many providers caring for children's respiratory health may have limited knowledge of the harms which may result in reduced discussion of ozone pollution during clinical encounters. Further, the current US air quality standard for ozone does not adequately protect children. In this nonsystematic review, we present basic background information for healthcare providers caring for children's respiratory health, review the US process for setting air quality standards, discuss the respiratory harms of ozone for healthy children and those with underlying respiratory disease, highlight the urgent need for a more protective ozone standard to adequately protect children's respiratory health, review impacts of climate change on ozone levels, and provide information for discussion in clinical encounters.
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Affiliation(s)
- Franziska Rosser
- Department of Pediatrics, Division of Pulmonary Medicine, University of Pittsburgh, School of Medicine, Pittsburgh, PA
| | - John Balmes
- Department of Medicine, University of California, San Francisco, San Francisco, CA
- School of Public Health, University of California, Berkeley, CA
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16
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Palinkas LA, De Leon J, Yu K, Salinas E, Fernandez C, Johnston J, Rahman MM, Silva SJ, Hurlburt M, McConnell RS, Garcia E. Adaptation Resources and Responses to Wildfire Smoke and Other Forms of Air Pollution in Low-Income Urban Settings: A Mixed-Methods Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:5393. [PMID: 37048007 PMCID: PMC10094253 DOI: 10.3390/ijerph20075393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 04/03/2023] [Accepted: 04/03/2023] [Indexed: 06/19/2023]
Abstract
Little is known about how low-income residents of urban communities engage their knowledge, attitudes, behaviors, and resources to mitigate the health impacts of wildfire smoke and other forms of air pollution. We interviewed 40 adults in Los Angeles, California, to explore their threat assessments of days of poor air quality, adaptation resources and behaviors, and the impacts of air pollution and wildfire smoke on physical and mental health. Participants resided in census tracts that were disproportionately burdened by air pollution and socioeconomic vulnerability. All participants reported experiencing days of poor air quality due primarily to wildfire smoke. Sixty percent received advanced warnings of days of poor air quality or routinely monitored air quality via cell phone apps or news broadcasts. Adaptation behaviors included remaining indoors, circulating indoor air, and wearing face masks when outdoors. Most (82.5%) of the participants reported some physical or mental health problem or symptom during days of poor air quality, but several indicated that symptom severity was mitigated by their adaptive behaviors. Although low-income residents perceive themselves to be at risk for the physical and mental health impacts of air pollution, they have also adapted to that risk with limited resources.
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Affiliation(s)
- Lawrence A. Palinkas
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA 90089, USA
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA 90089, USA
| | - Jessenia De Leon
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA 90089, USA
| | - Kexin Yu
- Department of Neurology, Oregon Health Sciences University, Portland, OR 97239, USA
| | - Erika Salinas
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA 90089, USA
| | - Cecilia Fernandez
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA 90089, USA
| | - Jill Johnston
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA 90089, USA
| | - Md Mostafijur Rahman
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA 90089, USA
| | - Sam J. Silva
- Department of Earth Sciences, Dornsife College of Letters, Arts and Sciences, University of Southern California, Los Angeles, CA 90089, USA
| | - Michael Hurlburt
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA 90089, USA
| | - Rob S. McConnell
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA 90089, USA
| | - Erika Garcia
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA 90089, USA
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Reyes-Angel J, Han YY, Forno E, Celedón JC, Rosser FJ. Parental knowledge and usage of air quality in childhood asthma management. Front Pediatr 2022; 10:966372. [PMID: 36440347 PMCID: PMC9687089 DOI: 10.3389/fped.2022.966372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 10/06/2022] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The current United States asthma management guidelines recommend usage of the Air Quality Index (AQI) for outdoor activity modification when air pollution is high. Little is known about parental knowledge and usage of air quality including the AQI in managing childhood asthma. METHODS Forty parents (or legal guardians) of children with persistent asthma completed a questionnaire designed to assess 4 areas related to outdoor air pollution: awareness, perception, behavioral modification, and prior healthcare provider discussion. Descriptive statistics were obtained and Fisher's exact test was used for analysis of behavioral change by selected variables. RESULTS Almost all parents reported awareness of air quality alerts or AQI, however, only 20% checked the AQI on the AirNow app or website. Most parents reported air pollution as a trigger (65%), yet few parents reported behavioral modification of their child's outdoor activity based on the perception of poor air quality (43%) or based on AQI or alerts (40%). Over half of parents reported a healthcare provider had ever discussed air pollution as a trigger, with few parents (23%) reporting recommendations for behavior change. Perception of air pollution as a trigger, healthcare provider discussion and recommendations, and usage of AirNow were associated with increased reported activity change. CONCLUSION Healthcare providers should discuss outdoor air pollution during asthma management in children and should discuss AirNow as a source for AQI information and behavioral recommendations.
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Affiliation(s)
- Jessica Reyes-Angel
- Department of Pediatrics, Division of Pulmonary Medicine, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA, United States
| | - Yueh-Ying Han
- Department of Pediatrics, Division of Pulmonary Medicine, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA, United States
| | - Erick Forno
- Department of Pediatrics, Division of Pulmonary Medicine, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA, United States
| | - Juan C Celedón
- Department of Pediatrics, Division of Pulmonary Medicine, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA, United States
| | - Franziska J Rosser
- Department of Pediatrics, Division of Pulmonary Medicine, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA, United States
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