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Karakas F, Grassie D, Schwartz Y, Dong J, Chalabi Z, Mumovic D, Mavrogianni A, Milner J. School building energy efficiency and NO 2 related risk of childhood asthma in England and Wales: Modelling study. THE SCIENCE OF THE TOTAL ENVIRONMENT 2023; 901:166109. [PMID: 37558063 DOI: 10.1016/j.scitotenv.2023.166109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 08/04/2023] [Accepted: 08/05/2023] [Indexed: 08/11/2023]
Abstract
BACKGROUND Climate change legislation will require dramatic increases in the energy efficiency of school buildings across the UK by 2050, which has the potential to affect air quality in schools. We assessed how different strategies for improving the energy efficiency of school buildings in England and Wales may affect asthma incidence and associated healthcare utilization costs in the future. METHODS Indoor concentrations of traffic-related NO2 were modelled inside school buildings representing 13 climate regions in England and Wales using a building physics school stock model. We used a health impact assessment model to quantify the resulting burden of childhood asthma incidence by combining regional health and population data with exposure-response functions from a recent high-quality systematic review/meta-analysis. We compared the effects of four energy efficiency interventions consisting of combinations of retrofit and operational strategies aiming to improve indoor air quality and thermal comfort on asthma incidence and associated hospitalization costs. RESULTS The highest childhood asthma incidence was found in the Thames Valley region (including London), in particular in older school buildings, while the lowest concentrations and health burdens were in the newest schools in Wales. Interventions consisting of only operational improvements or combinations of retrofit and operational strategies resulted in reductions in childhood asthma incidence (547 and 676 per annum regional average, respectively) and hospital utilization costs (£52,050 and £64,310 per annum regional average, respectively. Interventions that improved energy efficiency without operational measures resulted in higher childhood asthma incidence and hospital costs. CONCLUSION The effect of school energy efficiency retrofit on NO2 exposure and asthma incidence in schoolchildren depends critically on the use of appropriate building operation strategies. The findings from this study make several contributions to fill the knowledge gap about the impact of retrofitting schools on exposure to air pollutants and their effects on children's health.
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Affiliation(s)
- Filiz Karakas
- London School of Hygiene & Tropical Medicine, London, United Kingdom.
| | | | | | - Jie Dong
- University College London, London, United Kingdom
| | - Zaid Chalabi
- University College London, London, United Kingdom
| | | | | | - James Milner
- London School of Hygiene & Tropical Medicine, London, United Kingdom
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He Q, Wang Y, Qiu Q, Su Y, Wang Y, Wei H, Li J. Joint effects of air PM 2.5 and socioeconomic dimensions on posted emotions of urban green space visitors in cities experiencing population urbanization: A pilot study on 50 cities of East China. THE SCIENCE OF THE TOTAL ENVIRONMENT 2023; 861:160607. [PMID: 36460101 DOI: 10.1016/j.scitotenv.2022.160607] [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: 07/21/2022] [Revised: 11/02/2022] [Accepted: 11/26/2022] [Indexed: 06/17/2023]
Abstract
People may perceive and expose negative sentiments in days with PM2.5 pollutions, but evidence is still insufficient about the joint effects of PM2.5 and socioeconomic factors on human sentiments. In this study, a total of 8032 facial photos of urban green space visitors were obtained from Sina Weibo in 50 cities of East China and rated for happy, sad, neutral scores and net positive emotion index (NPE; happy minus sad). Seasonal air PM2.5 concentrations were collected from days when people exposed faces in cities that were categorized to medium, large, outsize, and mega sizes according to resident populations (RPs). In summer, people posted lower sad score (11.28 %) than in winter (13.51 %; P = 0.0357) and higher NPE (35.86 %) than in autumn (30.92 %; P = 0.0009). Multivariate linear regression on natural logarithms revealed that factors of gross domestic product per capita (parameter estimate: 0.45), RP (0.59), non-production electricity consumption (0.34), and length of road transport (0.34) together generated positive contributions to posted happy score, while the total retail trade of consumer goods (-1.25) and PM2.5 (-0.50) were perceived as joint depressors on NPE. Overall, cities with more rich households and activated retail sales attracted more people who exposed smiles in weathers with PM2.5 compared to cities where local economy is reliable on heavy industry. The summertime in mega cities will be recommended to enjoy a higher frequency to perceive satisfaction due to exposure to low PM2.5.
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Affiliation(s)
- Qian He
- College of Forestry and Landscape Architecture, South China Agricultural University, Guangzhou 510642, China.
| | - Yue Wang
- College of Forestry and Landscape Architecture, South China Agricultural University, Guangzhou 510642, China.
| | - Quan Qiu
- College of Forestry and Landscape Architecture, South China Agricultural University, Guangzhou 510642, China.
| | - Yan Su
- College of Forestry and Landscape Architecture, South China Agricultural University, Guangzhou 510642, China.
| | - Yang Wang
- Department of Arts & Social Sciences, National University of Singapore, Arts Link 117570, Singapore.
| | - Hongxu Wei
- Northeast Institute of Geography and Agroecology, Chinese Academy of Sciences, Changchun 130102, China; University of Chinese Academy of Sciences, Beijing 100049, China.
| | - Jiyue Li
- College of Forestry and Landscape Architecture, South China Agricultural University, Guangzhou 510642, China.
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Abstract
It is necessary to consider all aspects of environmental factors when assessing the health impact of an eco-building environment on its occupants. However, the multi-criteria and imprecise nature of the indoor-environment in the eco-buildings has caused difficulties in quantifying the indoor environmental pollution level. This paper describes the optimal classification and priority weight methods, which are particularly useful for assessing the indoor environmental quality (IEQ) of an eco-building to demonstrate its innovative applications. The analytic hierarchy process (AHP) was used to set up the strategic decision-making evaluation system for computing the indoor environment index (IEI) risk ranking of eco-buildings. Combined with this, a Microsoft Delphi-based IEQ intelligent forecasting software simulations package was developed, and the innovative application of indoor environmental comprehensive assessment was verified by a case study in Shanghai. The evaluation result was analyzed by the priority weight methods and the AHP decision-making system noted above. This health assessment method and system provides an innovative way for the indoor environment risk evaluation of eco-buildings and is helpful to standardize the local building market.
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Tieskens KF, Milando CW, Underhill LJ, Vermeer K, Levy JI, Fabian MP. The impact of energy retrofits on pediatric asthma exacerbation in a Boston multi-family housing complex: a systems science approach. Environ Health 2021; 20:14. [PMID: 33583411 PMCID: PMC7883428 DOI: 10.1186/s12940-021-00699-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 02/01/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Pediatric asthma is currently the most prevalent chronic disease in the United States, with children in lower income families disproportionately affected. This increased health burden is partly due to lower-quality and insufficient maintenance of affordable housing. A movement towards 'green' retrofits that improve energy efficiency and increase ventilation in existing affordable housing offers an opportunity to provide cost-effective interventions that can address these health disparities. METHODS We combine indoor air quality modeling with a previously developed discrete event model for pediatric asthma exacerbation to simulate the effects of different types of energy retrofits implemented at an affordable housing site in Boston, MA. RESULTS Simulation results show that retrofits lead to overall better health outcomes and healthcare cost savings if reduced air exchange due to energy-saving air tightening is compensated by mechanical ventilation. Especially when exposed to indoor tobacco smoke and intensive gas-stove cooking such retrofit would lead to an average annual cost saving of over USD 200, while without mechanical ventilation the same children would have experienced an increase of almost USD 200/year in health care utilization cost. CONCLUSION The combination of indoor air quality modeling and discrete event modeling applied in this paper can allow for the inclusion of health impacts in cost-benefit analyses of proposed affordable housing energy retrofits.
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Affiliation(s)
- Koen F. Tieskens
- Department of Environmental Health, Boston University School of Public Health, 715 Albany Street, Boston, MA 02118 USA
| | - Chad W. Milando
- Department of Environmental Health, Boston University School of Public Health, 715 Albany Street, Boston, MA 02118 USA
| | - Lindsay J. Underhill
- Department of Environmental Health, Boston University School of Public Health, 715 Albany Street, Boston, MA 02118 USA
| | - Kimberly Vermeer
- Urban Habitat Initiatives Inc, 328A Tremont Street, Boston, MA 02116 USA
| | - Jonathan I. Levy
- Department of Environmental Health, Boston University School of Public Health, 715 Albany Street, Boston, MA 02118 USA
| | - M. Patricia Fabian
- Department of Environmental Health, Boston University School of Public Health, 715 Albany Street, Boston, MA 02118 USA
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Underhill LJ, Dols WS, Lee SK, Fabian MP, Levy JI. Quantifying the impact of housing interventions on indoor air quality and energy consumption using coupled simulation models. JOURNAL OF EXPOSURE SCIENCE & ENVIRONMENTAL EPIDEMIOLOGY 2020; 30:436-447. [PMID: 31959901 PMCID: PMC7325860 DOI: 10.1038/s41370-019-0197-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 09/17/2019] [Accepted: 10/04/2019] [Indexed: 05/16/2023]
Abstract
While residential energy and ventilation standards aim to improve the energy performance and indoor air quality (IAQ) of homes, their combined impact across diverse residential activities and housing environments has not been well-established. This study demonstrates the insights that a recently-developed, freely-available coupled IAQ-energy modeling platform can provide regarding the energy and IAQ trade-offs of weatherization (i.e., sealing and insulation) and ventilation retrofits in multifamily housing across varied indoor occupant activity and mechanical ventilation scenarios in Boston, MA. Overall, it was found that combined weatherization and improved ventilation recommended by design standards could lead to both energy savings and IAQ-related benefits; however, ventilation standards may not be sufficient to protect against IAQ disbenefits for residents exposed to strong indoor sources (e.g., heavy cooking or smoking) and could lead to net increases in energy costs (e.g., due to the addition of continuous outdoor air ventilation). The modeling platform employed in this study is flexible and can be applied to a wide range of building typologies, retrofits, climates, and indoor occupant activities; therefore, it stands as a valuable tool for identifying cost-effective interventions that meet both energy efficiency and ventilation standards and improve IAQ across diverse housing populations.
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Affiliation(s)
- Lindsay J Underhill
- Department of Environmental Health, Boston University School of Public Health, 715 Albany Street, Boston, MA, 02118, USA.
| | - W Stuart Dols
- Engineering Laboratory, National Institute of Standards and Technology, 100 Bureau Drive, Gaithersburg, MD, 20899, USA
| | - Sharon K Lee
- Department of Environmental Health, Boston University School of Public Health, 715 Albany Street, Boston, MA, 02118, USA
| | - M Patricia Fabian
- Department of Environmental Health, Boston University School of Public Health, 715 Albany Street, Boston, MA, 02118, USA
| | - Jonathan I Levy
- Department of Environmental Health, Boston University School of Public Health, 715 Albany Street, Boston, MA, 02118, USA
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Alexander J, Edwards RA, Brodsky M, Savoldelli A, Manca L, Grugni R, Emir B, Whalen E, Watt S, Parsons B. Assessing the Value of Time Series Real-World and Clinical Trial Data vs. Baseline-Only Data in Predicting Responses to Pregabalin Therapy for Patients with Painful Diabetic Peripheral Neuropathy. Clin Drug Investig 2019; 39:775-786. [PMID: 31243706 DOI: 10.1007/s40261-019-00812-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND OBJECTIVE Treatment challenges necessitate new approaches to customize care to individual patient needs. Integrating data from randomized controlled trials and observational studies may reduce potential covariate biases, yielding information to improve treatment outcomes. The objective of this study was to predict pregabalin responses, in individuals with painful diabetic peripheral neuropathy, by examining time series data (lagged inputs) collected after treatment initiation vs. baseline using microsimulation. METHODS The platform simulated pregabalin-treated patients to estimate hypothetical future pain responses over 6 weeks based on six distinct time series regressions with lagged variables as inputs (hereafter termed "time series regressions"). Data were from three randomized controlled trials (N = 398) and an observational study (N = 3159). Regressions were derived after performing a hierarchical cluster analysis with a matched patient dataset from coarsened exact matching. Regressions were validated using unmatched (observational study vs. randomized controlled trial) patients. Predictive implications (of 6-week outcomes) were compared using only baseline vs. 1- to 2-week prior data. RESULTS Time series regressions for pain performed well (adjusted R2 0.85-0.91; root mean square error 0.53-0.57); those with only baseline data performed less well (adjusted R2 0.13-0.44; root mean square error 1.11-1.40). Simulated patient distributions yielded positive predictive values for > 50% pain score improvements from baseline for the six clusters (287-777 patients each; range 0.87-0.98). CONCLUSIONS Effective prediction of pregabalin response for painful diabetic peripheral neuropathy was accomplished through combining cluster analyses, coarsened exact matching, and time series regressions, reflecting distinct patterns of baseline and "on-treatment" variables. These results advance the understanding of microsimulation to predict patient treatment responses through integration and inter-relationships of multiple, complex, and time-dependent characteristics.
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Affiliation(s)
| | - Roger A Edwards
- Health Services Consulting Corporation, 169 Summer Road, Boxborough, MA, 01719, USA.
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Modeling the Impact of an Indoor Air Filter on Air Pollution Exposure Reduction and Associated Mortality in Urban Delhi Household. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16081391. [PMID: 30999693 PMCID: PMC6518106 DOI: 10.3390/ijerph16081391] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 04/13/2019] [Accepted: 04/14/2019] [Indexed: 11/16/2022]
Abstract
Indoor exposure to fine particulate matter (PM2.5) is a prominent health concern. However, few studies have examined the effectiveness of long-term use of indoor air filters for reduction of PM2.5 exposure and associated decrease in adverse health impacts in urban India. We conducted 20 simulations of yearlong personal exposure to PM2.5 in urban Delhi using the National Institute of Standards and Technology's CONTAM program (NIST, Gaithersburg, MD, USA). Simulation scenarios were developed to examine different air filter efficiencies, use schedules, and the influence of a smoker at home. We quantified associated mortality reductions with Household Air Pollution Intervention Tool (HAPIT, University of California, Berkeley, CA, USA). Without an air filter, we estimated an annual mean PM2.5 personal exposure of 103 µg/m3 (95% Confidence Interval (CI): 93, 112) and 137 µg/m3 (95% CI: 125, 149) for households without and with a smoker, respectively. All day use of a high-efficiency particle air (HEPA) filter would reduce personal PM2.5 exposure to 29 µg/m3 and 30 µg/m3, respectively. The reduced personal PM2.5 exposure from air filter use is associated with 8-37% reduction in mortality attributable to PM2.5 pollution in Delhi. The findings of this study indicate that air filter may provide significant improvements in indoor air quality and result in health benefits.
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Khreis H, de Hoogh K, Nieuwenhuijsen MJ. Full-chain health impact assessment of traffic-related air pollution and childhood asthma. ENVIRONMENT INTERNATIONAL 2018; 114:365-375. [PMID: 29602620 DOI: 10.1016/j.envint.2018.03.008] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Revised: 03/04/2018] [Accepted: 03/07/2018] [Indexed: 05/28/2023]
Abstract
BACKGROUND Asthma is the most common chronic disease in children. Traffic-related air pollution (TRAP) may be an important exposure contributing to its development. In the UK, Bradford is a deprived city suffering from childhood asthma rates higher than national and regional averages and TRAP is of particular concern to the local communities. AIMS We estimated the burden of childhood asthma attributable to air pollution and specifically TRAP in Bradford. Air pollution exposures were estimated using a newly developed full-chain exposure assessment model and an existing land-use regression model (LUR). METHODS We estimated childhood population exposure to NOx and, by conversion, NO2 at the smallest census area level using a newly developed full-chain model knitting together distinct traffic (SATURN), vehicle emission (COPERT) and atmospheric dispersion (ADMS-Urban) models. We compared these estimates with measurements and estimates from ESCAPE's LUR model. Using the UK incidence rate for childhood asthma, meta-analytical exposure-response functions, and estimates from the two exposure models, we estimated annual number of asthma cases attributable to NO2 and NOx in Bradford, and annual number of asthma cases specifically attributable to traffic. RESULTS The annual average census tract levels of NO2 and NOx estimated using the full-chain model were 15.41 and 25.68 μg/m3, respectively. On average, 2.75 μg/m3 NO2 and 4.59 μg/m3 NOx were specifically contributed by traffic, without minor roads and cold starts. The annual average census tract levels of NO2 and NOx estimated using the LUR model were 21.93 and 35.60 μg/m3, respectively. The results indicated that up to 687 (or 38% of all) annual childhood asthma cases in Bradford may be attributable to air pollution. Up to 109 cases (6%) and 219 cases (12%) may be specifically attributable to TRAP, with and without minor roads and cold starts, respectively. CONCLUSIONS This is the first study undertaking full-chain health impact assessment of TRAP and childhood asthma in a disadvantaged population with public concern about TRAP. It further adds to scarce literature exploring the impact of different exposure assessments. In conservative estimates, air pollution and TRAP are estimated to cause a large, but largely preventable, childhood asthma burden. Future progress with childhood asthma requires a move beyond the prevalent disease control-based approach toward asthma prevention.
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Affiliation(s)
- Haneen Khreis
- Texas A&M Transportation Institute (TTI) and Center for Advancing Research in Transportation Emissions, Energy, and Health (CARTEEH), TX, United States of America; ISGlobal, Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiologia y Salud Publica (CIBERESP), Madrid, Spain; Institute for Transport Studies (ITS), University of Leeds, Leeds, United Kingdom.
| | - Kees de Hoogh
- Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland; Swiss Tropical and Public Health Institute, Socinstrasse 57, 4051 Basel, Switzerland.
| | - Mark J Nieuwenhuijsen
- ISGlobal, Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiologia y Salud Publica (CIBERESP), Madrid, Spain.
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Cross-Disciplinary Consultancy to Enhance Predictions of Asthma Exacerbation Risk in Boston. Online J Public Health Inform 2016; 8:e199. [PMID: 28210420 PMCID: PMC5302473 DOI: 10.5210/ojphi.v8i3.6902] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
This paper continues an initiative conducted by the International Society for Disease Surveillance with funding from the Defense Threat Reduction Agency to connect near-term analytical needs of public health practice with technical expertise from the global research community. The goal is to enhance investigation capabilities of day-to-day population health monitors. A prior paper described the formation of consultancies for requirements analysis and dialogue regarding costs and benefits of sustainable analytic tools. Each funded consultancy targets a use case of near-term concern to practitioners. The consultancy featured here focused on improving predictions of asthma exacerbation risk in demographic and geographic subdivisions of the city of Boston, Massachusetts, USA based on the combination of known risk factors for which evidence is routinely available. A cross-disciplinary group of 28 stakeholders attended the consultancy on March 30-31, 2016 at the Boston Public Health Commission. Known asthma exacerbation risk factors are upper respiratory virus transmission, particularly in school-age children, harsh or extreme weather conditions, and poor air quality. Meteorological subject matter experts described availability and usage of data sources representing these risk factors. Modelers presented multiple analytic approaches including mechanistic models, machine learning approaches, simulation techniques, and hybrids. Health department staff and local partners discussed surveillance operations, constraints, and operational system requirements. Attendees valued the direct exchange of information among public health practitioners, system designers, and modelers. Discussion finalized design of an 8-year de-identified dataset of Boston ED patient records for modeling partners who sign a standard data use agreement.
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Levy JI, Fabian MP, Peters JL. Meta-Analytic Approaches for Multistressor Dose-Response Function Development: Strengths, Limitations, and Case Studies. RISK ANALYSIS : AN OFFICIAL PUBLICATION OF THE SOCIETY FOR RISK ANALYSIS 2015; 35:1040-1049. [PMID: 24724810 DOI: 10.1111/risa.12208] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
For many policy analyses, including but not limited to cumulative risk assessments, it is important to characterize the individual and joint health effects of multiple stressors. With an increasing focus on psychosocial and other nonchemical stressors, this often includes epidemiological meta-analysis. Meta-analysis has limitations if epidemiological studies do not include all of the stressors of interest or do not provide multivariable outputs in a format necessary for risk assessment. Given these limitations, novel analytical methods are often needed to synthesize the published literature or to build upon available evidence. In this article, we discuss three recent case studies that highlight the strengths and limitations of meta-analytic approaches and other research synthesis techniques for human health risk assessment applications. First, a literature-based meta-analysis within a risk assessment context informed the design of a new epidemiological investigation of the differential toxicity of fine particulate matter constituents. Second, a literature synthesis for an effects-based cumulative risk assessment of hypertension risk factors led to a decision to develop new epidemiological associations using structural equation modeling. Third, discrete event simulation modeling was used to simulate the impact of changes in the built environment on environmental exposures and associated asthma outcomes, linking literature meta-analyses for key associations with a simulation model to synthesize all of the model components. These case studies emphasize the importance of conducting epidemiology with a risk assessment application in mind, the need for interdisciplinary collaboration, and the value of advanced analytical methods to synthesize epidemiological and other evidence for risk assessment applications.
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Affiliation(s)
- Jonathan I Levy
- Department of Environmental Health, Boston University School of Public Health, Boston, MA, USA
| | - M Patricia Fabian
- Department of Environmental Health, Boston University School of Public Health, Boston, MA, USA
| | - Junenette L Peters
- Department of Environmental Health, Boston University School of Public Health, Boston, MA, USA
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Coker ES, Smit E, Harding AK, Molitor J, Kile ML. A cross sectional analysis of behaviors related to operating gas stoves and pneumonia in U.S. children under the age of 5. BMC Public Health 2015; 15:77. [PMID: 25648867 PMCID: PMC4321321 DOI: 10.1186/s12889-015-1425-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Accepted: 01/15/2015] [Indexed: 01/31/2023] Open
Abstract
Background Poorly ventilated combustion stoves and pollutants emitted from combustion stoves increase the risk of acute lower respiratory illnesses (ALRI) in children living in developing countries but few studies have examined these issues in developed countries. Our objective is to investigate behaviors related to gas stove use, namely using them for heat and without ventilation, on the odds of pneumonia and cough in U.S. children. Methods The National Health and Nutrition Examination Survey (1988–1994) was used to identify children < 5 years who lived in homes with a gas stove and whose parents provided information on their behaviors when operating their gas stoves and data on pneumonia (N = 3,289) and cough (N = 3,127). Multivariate logistic regression models were used to examine the association between each respiratory outcome and using a gas stove for heat or without ventilation, as well as, the joint effect of both behaviors. Results The adjusted odds of parental-reported pneumonia (adjusted odds ratio [aOR] = 2.08, 95% confidence interval [CI]: 1.08, 4.03) and cough (aOR = 1.66, 95% CI: 1.14, 2.43) were higher among children who lived in homes where gas stoves were used for heat compared to those who lived in homes where gas stoves were only used for cooking. The odds of pneumonia (aOR = 1.76, 95% CI: 1.04, 2.98), but not cough (aOR = 1.23, 95% CI: 0.87, 1.75), was higher among those children whose parents did not report using ventilation when operating gas stoves compared to those who did use ventilation. When considering the joint association of both stove operating conditions, only children whose parents reported using gas stoves for heat without ventilation had significantly higher odds of pneumonia (aOR = 3.06, 95% CI: 1.32, 7.09) and coughing (aOR = 2.07, 95% CI: 1.29, 3.30) after adjusting for other risk factors. Conclusions Using gas stoves for heat without ventilation was associated with higher odds of pneumonia and cough among U.S. children less than five years old who live in homes with a gas stove. More research is needed to determine if emissions from gas stoves ventilation infrastructure, or modifiable behaviors contribute to respiratory infections in children.
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Affiliation(s)
- Eric S Coker
- College of Public Health and Human Sciences, Oregon State University, Milam Hall, Corvallis, OR, 97331, USA.
| | - Ellen Smit
- College of Public Health and Human Sciences, Oregon State University, Milam Hall, Corvallis, OR, 97331, USA.
| | - Anna K Harding
- College of Public Health and Human Sciences, Oregon State University, Milam Hall, Corvallis, OR, 97331, USA.
| | - John Molitor
- College of Public Health and Human Sciences, Oregon State University, Milam Hall, Corvallis, OR, 97331, USA.
| | - Molly L Kile
- College of Public Health and Human Sciences, Oregon State University, Milam Hall, Corvallis, OR, 97331, USA.
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Dammann O, Gray P, Gressens P, Wolkenhauer O, Leviton A. Systems Epidemiology: What's in a Name? Online J Public Health Inform 2014; 6:e198. [PMID: 25598870 PMCID: PMC4292535 DOI: 10.5210/ojphi.v6i3.5571] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Systems biology is an interdisciplinary effort to integrate molecular, cellular, tissue, organ, and organism levels of function into computational models that facilitate the identification of general principles. Systems medicine adds a disease focus. Systems epidemiology adds yet another level consisting of antecedents that might contribute to the disease process in populations. In etiologic and prevention research, systems-type thinking about multiple levels of causation will allow epidemiologists to identify contributors to disease at multiple levels as well as their interactions. In public health, systems epidemiology will contribute to the improvement of syndromic surveillance methods. We encourage the creation of computational simulation models that integrate information about disease etiology, pathogenetic data, and the expertise of investigators from different disciplines.
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Affiliation(s)
- O. Dammann
- Dept of Public Health and Community Medicine, Tufts
University School of Medicine, Boston, MA
- Perinatal Epidemiology Unit, Dept. of Gynecology and
Obstetrics, Hannover Medical School, Hannover, Germany
| | - P. Gray
- Dept of Public Health and Community Medicine, Tufts
University School of Medicine, Boston, MA
| | - P. Gressens
- Inserm, U676, Paris, France
- Department of Perinatal Imaging and Health,
Department of Division of Imaging Sciences and Biomedical Engineering,
King’s College London, King’s Health Partners, St. Thomas’
Hospital, London, United Kingdom
| | - O. Wolkenhauer
- Department of Systems Biology and Bioinformatics,
University of Rostock, Rostock, Germany
- Stellenbosch Institute for Advanced Study (STIAS),
Stellenbosch, South Africa
| | - A. Leviton
- Neuroepidemiology Unit, Children’s Hospital,
Boston, MA
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13
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Colton MD, MacNaughton P, Vallarino J, Kane J, Bennett-Fripp M, Spengler JD, Adamkiewicz G. Indoor air quality in green vs conventional multifamily low-income housing. ENVIRONMENTAL SCIENCE & TECHNOLOGY 2014; 48:7833-41. [PMID: 24941256 DOI: 10.1021/es501489u] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Indoor air quality is an important predictor of health, especially in low-income populations. It is unclear how recent trends in "green" building affect the indoor exposure profile. In two successive years, we conducted environmental sampling, home inspections, and health questionnaires with families in green and conventional (control) apartments in two public housing developments. A subset of participants was followed as they moved from conventional to green or conventional to conventional housing. We measured particulate matter less than 2.5 μm aerodynamic diameter (PM2.5), formaldehyde, nitrogen dioxide (NO2), nicotine, carbon dioxide (CO2), and air exchange rate (AER) over a seven-day sampling period coincident with survey administration. In multivariate models, we observed 57%, 65%, and 93% lower concentrations of PM2.5, NO2, and nicotine (respectively) in green vs control homes (p=0.032, p<0.001, p=0.003, respectively), as well as fewer reports of mold, pests, inadequate ventilation, and stuffiness. Differences in formaldehyde and CO2 were not statistically significant. AER was marginally lower in green buildings (p=0.109). Participants in green homes experienced 47% fewer sick building syndrome symptoms (p<0.010). We observed significant decreases in multiple indoor exposures and improved health outcomes among participants who moved into green housing, suggesting multilevel housing interventions have the potential to improve long-term resident health.
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Affiliation(s)
- Meryl D Colton
- Department of Environmental Health, Harvard School of Public Health , Boston 02215, Massachusetts, United States
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A simulation model of building intervention impacts on indoor environmental quality, pediatric asthma, and costs. J Allergy Clin Immunol 2013; 133:77-84. [PMID: 23910689 DOI: 10.1016/j.jaci.2013.06.003] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2012] [Revised: 05/29/2013] [Accepted: 06/03/2013] [Indexed: 11/22/2022]
Abstract
BACKGROUND Although indoor environmental conditions can affect pediatric asthmatic patients, few studies have characterized the effect of building interventions on asthma-related outcomes. Simulation models can evaluate such complex systems but have not been applied in this context. OBJECTIVE We sought to evaluate the impact of building interventions on indoor environmental quality and pediatric asthma health care use, and to conduct cost comparisons between intervention and health care costs and energy savings. METHODS We applied our previously developed discrete event simulation model (DEM) to simulate the effect of environmental factors, medication compliance, seasonality, and medical history on (1) pollutant concentrations indoors and (2) asthma outcomes in low-income multifamily housing. We estimated health care use and costs at baseline and subsequent to interventions, and then compared health care costs with energy savings and intervention costs. RESULTS Interventions, such as integrated pest management and repairing kitchen exhaust fans, led to 7% to 12% reductions in serious asthma events with 1- to 3-year payback periods. Weatherization efforts targeted solely toward tightening a building envelope led to 20% more serious asthma events, but bundling with repairing kitchen exhaust fans and eliminating indoor sources (eg, gas stoves or smokers) mitigated this effect. CONCLUSION Our pediatric asthma model provides a tool to prioritize individual and bundled building interventions based on their effects on health and costs, highlighting the tradeoffs between weatherization, indoor air quality, and health. Our work bridges the gap between clinical and environmental health sciences by increasing physicians' understanding of the effect that home environmental changes can have on their patients' asthma.
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