Urban tree canopy and asthma, wheeze, rhinitis, and allergic sensitization to tree pollen in a New York City birth cohort

Residential greenness during pregnancy and early life and development of asthma up to 27 years of age: The Espoo Cohort Study

Previous studies have suggested that living close to green spaces has protective health effects, but potential effects on asthma are contradictory. We investigated the association between the amount of greenness in the residential area during pregnancy and early life and development of asthma in the first 27 years of life. The study population included all 2568 members of the Espoo Cohort Study, Finland. We calculated individual-level exposure to green space measured as cumulative Normalized Difference Vegetation Index (cumNDVI in unit-months) within 300 m of the participant's residence during pregnancy and the first two years of life in both spring and summer seasons. The onset of asthma was assessed using information from the baseline and follow-up surveys. Exposure to residential greenness in the spring season during pregnancy was associated with an increased risk of asthma up to 6 years of age, with an adjusted hazard ratio (aHR) of 3.72 (95% confidence interval (CI): 1.11, 12.47) per 1 unit increase in cumNDVI. Increased greenness in the summer during pregnancy associated with asthma up to 6 years, with an aHR of 1.41 (95% CI: 0.85, 2.32). The effect was found to be related to increased greenness particularly during the third trimester of pregnancy, with an aHR of 2.37 (95% CI: 1.36, 4.14) per 1 unit increase of cumNDVI. These associations were weaker at the ages of 12 and 27 years. No association was found between NDVI in the first two years of life and the development of asthma. Our findings provide novel evidence that exposure to greenness during pregnancy increases the risk of developing asthma. The adverse effects were strongest for the prenatal greenness in the spring season and in the third trimester of pregnancy. Both the season and trimester of exposure to greenness are critical in the development of asthma.

NPCC4: Climate change and New York City's health risk

This chapter of the New York City Panel on Climate Change 4 (NPCC4) report considers climate health risks, vulnerabilities, and resilience strategies in New York City's unique urban context. It updates evidence since the last health assessment in 2015 as part of NPCC2 and addresses climate health risks and vulnerabilities that have emerged as especially salient to NYC since 2015. Climate health risks from heat and flooding are emphasized. In addition, other climate-sensitive exposures harmful to human health are considered, including outdoor and indoor air pollution, including aeroallergens; insect vectors of human illness; waterborne infectious and chemical contaminants; and compounding of climate health risks with other public health emergencies, such as the COVID-19 pandemic. Evidence-informed strategies for reducing future climate risks to health are considered.

Residential surrounding greenness and the incidence of childhood asthma: Findings from a population-based cohort in Ontario, Canada

Several epidemiological studies have investigated the possible role that living in areas with greater amounts of greenspace has on the incidence of childhood asthma. These findings have been inconsistent, and few studies explored the relevance of timing of exposure. We investigated the role of residential surrounding greenness on the risk of incident asthma using a population-based retrospective cohort study. We included 982,131 singleton births in Ontario, Canada between 2006 and 2013. Two measures of greenness, the Normalized Difference Vegetation Index (NDVI) and the Green View Index (GVI), were assigned to the residential histories of these infants from pregnancy through to 12 years of age. Longitudinally-based diagnoses of asthma were determined by using provincial administrative health data. The extended Cox hazards model was used to characterize associations between greenness measures and asthma (up to age 12 years) while adjusting for several risk factors. In a fully adjusted model, that included a term for traffic-related air pollution (NO2), we found no association between an interquartile range increase (0.08) of the NDVI during childhood and asthma incidence (HR = 0.99; 95 % CI = 0.99-1.01). In contrast, we found that an 0.08 increase in NDVI during childhood reduced the risk of asthma in children 7-12 years of age by 14 % (HR = 0.86, 95 % CI:0.79-0.95). Seasonal differences in the association between greenness and asthma were noted. Our findings suggest that residential proximity to greenness reduces the risk of asthma in children aged 7-12.

Different greenness exposure in Europe and respiratory outcomes in youths. A systematic review and meta-analysis

The existing evidence on the association between greenness and respiratory outcomes remains inconclusive. We aimed at systematically summarizing existing literature on greenness exposure and respiratory outcomes in European children and adolescents, with a preliminary attempt to qualify the distribution of dominant tree species across different geographical areas and bioclimatic regions. Overall, 4049 studies were firstly identified by searching PubMed/MEDLINE, EMBASE, Scopus, Web of Science, GreenFile and CAB direct, up to 29 August 2023. Eighteen primary studies were included in the systematic review and six were meta-analyzed. No overall significant association was observed between the Normalized Difference Vegetation Index, assessed within 500-m buffers (i.e. NDVI-500), and the odds of asthma for 0.3-increase in the exposure (OR: 0.97, 95% CI from 0.53 to 1.78). Similarly, an overall exposure to the NDVI-300 highest tertile, as compared to the lowest tertile, was not significantly associated with asthma (OR: 0.65, 95% CI from 0.22 to 1.91): heterogeneity among studies was significant (p = 0.021). We delineated some key elements that might have mostly contributed to the lack of scientific consensus on this topic, starting from the urgent need of harmonized approaches for the operational definition of greenness. Additionally, the complex interplay between greenness and respiratory health may vary across different geographical regions and climatic conditions. At last, the inconsistent findings may reflect the heterogeneity and complexity of this relationship, rather than a lack of scientific consensus itself. Future research should compare geographical areas with similar bioclimatic parameters and dominant or potentially present vegetation species, in order to achieve a higher inter-study comparability.

A toxicological perspective on climate change and the exposome

Climate change is accompanied by changes in the exposome, including increased heat, ground-level ozone, and other air pollutants, infectious agents, pollens, and psychosocial stress. These exposures alter the internal component of the exposome and account for some of the health effects of climate change. The adverse outcome pathways describe biological events leading to an unfavorable health outcome. In this perspective study, I propose to use this toxicological framework to better describe the biological steps linking a stressor associated with climate change to an adverse outcome. Such a framework also allows for better identification of possible interactions between stressors related to climate change and others, such as chemical pollution. More generally, I call for the incorporation of climate change as part of the exposome and for improved identification of the biological pathways involved in its health effects.

Reassessing the role of urban green space in air pollution control

The assumption that vegetation improves air quality is prevalent in scientific, popular, and political discourse. However, experimental and modeling studies show the effect of green space on air pollutant concentrations in urban settings is highly variable and context specific. We revisited the link between vegetation and air quality using satellite-derived changes of urban green space and air pollutant concentrations from 2,615 established monitoring stations over Europe and the United States. Between 2010 and 2019, stations recorded declines in ambient NO2, (particulate matter) PM10, and PM2.5 (average of -3.14% y-1), but not O3 (+0.5% y-1), pointing to the general success of recent policy interventions to restrict anthropogenic emissions. The effect size of total green space on air pollution was weak and highly variable, particularly at the street scale (15 to 60 m radius) where vegetation can restrict ventilation. However, when isolating changes in tree cover, we found a negative association with air pollution at borough to city scales (120 to 16,000 m) particularly for O3 and PM. The effect of green space was smaller than the pollutant deposition and dispersion effects of meteorological drivers including precipitation, humidity, and wind speed. When averaged across spatial scales, a one SD increase in green space resulted in a 0.8% (95% CI: -3.5 to 2%) decline in air pollution. Our findings suggest that while urban greening may improve air quality at the borough-to-city scale, the impact is moderate and may have detrimental street-level effects depending on aerodynamic factors like vegetation type and urban form.

The impact of perinatal and at birth risk factors on the progression from preschool wheezing to adolescent asthma

Asthma is a global health concern affecting millions of children and adolescents. This review focuses on the possible factors that are associated with the transition from preschool wheezing to childhood asthma and highlights the significance of early-life environmental exposures during pregnancy and the first 6 months of life in shaping allergies and asthma. We observed a scarcity of studies investigating this subgroup, with most focusing on wheezing trajectories. We undertook a thorough investigation of diverse perinatal exposures that have the potential to impact this transition. These factors include maternal asthma, smoking during pregnancy, diet, prepregnancy weight, infant birthweight, gestational age, and breastfeeding. Although limited, studies do suggest that maternal asthma increases the likelihood of preschool wheeze in offspring that persists through childhood with potential asthma progression. Findings concerning other perinatal exposures remain inconsistent. Further research is needed to identify asthma progression risk factors and assess perinatal exposure effects.

Impact of socioeconomic factors on allergic diseases

Allergic and immunologic conditions, including asthma, food allergy, atopic dermatitis, and allergic rhinitis, are among the most common chronic conditions in children and adolescents that often last into adulthood. Although rare, inborn errors of immunity are life-altering and potentially fatal if unrecognized or untreated. Thus, allergic and immunologic conditions are both medical and public health issues that are profoundly affected by socioeconomic factors. Recently, studies have highlighted societal issues to evaluate factors at multiple levels that contribute to health inequities and the potential steps toward closing those gaps. Socioeconomic disparities can influence all aspects of care, including health care access and quality, diagnosis, management, education, and disease prevalence and outcomes. Ongoing research, engagement, and deliberate investment of resources by relevant stakeholders and advocacy approaches are needed to identify and address the impact of socioeconomics on health care disparities and outcomes among patients with allergic and immunologic diseases.

The Built Environment and Pediatric Health

Buildings, parks, and roads are all elements of the "built environment," which can be described as the human-made structures that comprise the neighborhoods and communities where people live, work, learn, and recreate (https://www.epa.gov/smm/basic-information-about-built-environment). The design of communities where children and adolescents live, learn, and play has a profound impact on their health. Moreover, the policies and practices that determine community design and the built environment are a root cause of disparities in the social determinants of health that contribute to health inequity. An understanding of the links between the built environment and pediatric health will help to inform pediatricians' and other pediatric health professionals' care for patients and advocacy on their behalf. This technical report describes the range of pediatric physical and mental health conditions influenced by the built environment, as well as historical and persistent effects of the built environment on health disparities. The accompanying policy statement outlines community design solutions that can improve pediatric health and health equity, including opportunities for pediatricians and the health care sector to incorporate this knowledge in patient care, as well as to play a role in advancing a health-promoting built environment for all children and families.

Villeneuve P, Kaiser DJ, Smargiassi A. The influence of urban trees and total vegetation on asthma development in children

Objective

We aimed to assess whether the influence of urban vegetation on asthma development in children (<13 years) varies by type (e.g., total vegetation, tree type, and grass) and season.

Methods

We used a cohort of all children born in Montreal, Canada, between 2000 and 2015. Children and cases were identified from linked medico-administrative databases. Exposure to residential vegetation was estimated using the Normalized Difference Vegetation Index (NDVI) for total vegetation and using the total area covered by deciduous and evergreen crowns for trees in 250 m buffers centered on residential postal codes. Seasonal variations in vegetation were modeled by setting values to zero on days outside of pollen and leaf-on seasons. Cox models with vegetation exposures, age as a time axis, and adjusted for sex, material deprivation, and health region were used to estimate hazard ratios (HR) for asthma development.

Results

We followed 352,946 children for a total of 1,732,064 person-years and identified 30,816 incident cases of asthma. While annual vegetation (total and trees) measures did not appear to be associated with asthma development, models for pollen and leaf-on seasons yielded significant nonlinear associations. The risk of developing asthma was lower in children exposed to high levels (>33,300 m2) of deciduous crown area for the leaf-on season (HR = 0.69; 95% confidence interval [CI] = 0.67, 0.72) and increased for the pollen season (HR = 1.07; 95% CI =1.02, 1.12), compared with unexposed children. Similar results were found with the Normalized Difference Vegetation Index.

Conclusion

The relationship between urban vegetation and childhood asthma development is nonlinear and influenced by vegetation characteristics, from protective during the leaf-on season to harmful during the pollen season.

The relationship between tree canopy and social capital on physical activity in college students

OBJECTIVE

Rates of physical activity (PA) are low, especially among college students. Tree canopy and social capital have been correlated with higher rates of PA. This study assessed the relationship between tree canopy and social capital on minutes of PA.

PARTICIPANTS

Students from the University of Nevada, Las Vegas, located in Southern Nevada, were surveyed on social capital and self-reported minutes of PA.

METHODS

Tree canopy coverage was calculated within a 1 km walk buffer around each participant's home. Logistic regression was used to determine if tree canopy and social capital predicted meeting PA recommendations of 150 minutes/week.

RESULTS

42.4% of participants met the PA recommendations and males were more likely than females to meet them (odds ratio [OR] = 0.517). Social capital was a significant predictor of PA (OR = 1.308) while tree canopy was not.

CONCLUSIONS

Exploration of social capital to increase PA and further investigations into correlates of PA for college students in sprawling desert environments are recommended.

Early-life environment and the risk of eczema at 2 years-Meta-analyses of six Finnish birth cohorts

BACKGROUND

Urban-related nature exposures are suggested to contribute to the rising prevalence of allergic diseases despite little supporting evidence. Our aim was to evaluate the impact of 12 land cover classes and two greenness indices around homes at birth on the development of doctor-diagnosed eczema by the age of 2 years, and the influence of birth season.

METHODS

Data from 5085 children were obtained from six Finnish birth cohorts. Exposures were provided by the Coordination of Information on the Environment in three predefined grid sizes. Adjusted logistic regression was run in each cohort, and pooled effects across cohorts were estimated using fixed or random effect meta-analyses.

RESULTS

In meta-analyses, neither greenness indices (NDVI or VCDI, 250 m × 250 m grid size) nor residential or industrial/commercial areas were associated with eczema by age of 2 years. Coniferous forest (adjusted odds ratio 1.19; 95% confidence interval 1.01-1.39 for the middle and 1.16; 0.98-1.28 for the highest vs. lowest tertile) and mixed forest (1.21; 1.02-1.42 middle vs. lowest tertile) were associated with elevated eczema risk. Higher coverage with agricultural areas tended to associate with elevated eczema risk (1.20; 0.98-1.48 vs. none). In contrast, transport infrastructure was inversely associated with eczema (0.77; 0.65-0.91 highest vs. lowest tertile).

CONCLUSION

Greenness around the home during early childhood does not seem to protect from eczema. In contrast, nearby coniferous and mixed forests may increase eczema risk, as well as being born in spring close to forest or high-green areas.

The effect of greenness on allergic rhinitis outcomes in children and adolescents: A systematic review and meta-analysis

BACKGROUND

The relationship between greenness and health emerges as new public health concern. More published studies from multiple areas have explored the relationship between greenness and allergic rhinitis (AR) in children and adolescents. This study aims to determine the association between greenness and allergic rhinitis by systematic review and meta-analysis, in order to provide a more comprehensive assessment of the impact of greenness on AR in children and adolescents.

METHODS

The relative literature was systematically searched in PubMed, Embase, and Web of science lastly on September 25, 2022. Terms related to greenness and allergic rhinitis were used for searching. Summary effect estimates of greenness on AR in children and adolescents were calculated for per 10 % increase of greenness exposure with different buffer sizes by random-effects model.

RESULTS

A total of 579 studies were screened, and fourteen studies from Europe, Asia and North America were finally included. Most greenness exposure were measured by normalized difference vegetation index (NDVI). Enhanced vegetation index, outdoor-green environmental score and existed to measuring different greenness types. Greenness surrounding residences and schools were assessed. The overall effect of greenness on primary outcome was 1.00 (95%CI = 0.99-1.00). Most effect estimates of greenness were included in the NDVI-500 m group, and the pooled OR was 0.99 (95%CI = 0.97-1.01). No significant pooled estimates were found in analyses with study locations.

CONCLUSION

This study indicates no significant association between greenness exposure and AR in children and adolescents. Various exposure measures and conversion of data may affect the results of this meta-analysis. More precise assessment of personal greenness exposure in well-designed prospective studies are vital for drawing a definite association in future. Furthermore, greenness exposure surrounding schools should be paid considerable attention for its effect on AR in school-aged children and adolescents.

Urban Air Pollution and Greenness in Relation to Public Health

Background

Air pollution is the result of economic growth and urbanization. Air pollution has been progressively recognized as a serious problem for cities, through widespread effects on health and well-being. There is less concern from stakeholders about greenness and air pollution mitigating factors in an urban area. This research targeted to indicate the spatial dissemination of greenery, air quality levels (PM_2.5, PM₁₀, CO₂, and AQI), and exposure to air quality-related health risks for the people in the urban area.

Method

The data were collected by measuring air quality at transportation stations and manufacturing industries with Air visual pro, then observing and mapping greenness in the city within the administrative boundary by GIS (street greenery, forest, availability of greenness in the manufacturing industry), and lastly questionnaire and interview were employed for air quality-related health issues. Then, the air quality data were analyzed by using USAQI standards and health messages. Both quantitative and qualitative research approach had employed to explore air pollution levels, availability of greenness, and air quality-related health issues. Moreover, Health questionnaires and greenness were correlated with air quality levels by a simple linear regression model.

Result

The result indicated that there was unhealthy air quality in the transportation and manufacturing industries. The measured air quality showed in a range of 50.13-96.84 μg/m³ of PM_2.5, 645-1764 ppm of CO_2, and 137-179 Air quality index (AQI). The highest mean of PM_2.5 and air quality concentrations at Addis Ababa transportation stations and manufacturing sites ranged between 63.46 and 104.45 μg/m³ and 179-326, respectively. It was observed with less street greenery and greenness available in residential, commercial areas, and manufacturing industries. The pollution level was beyond the limit of WHO standards. The result has shown a health risk to the public in the city, particularly for drivers, street vendors, and manufacturing industry employees. Among 480 respondents, 57.92% experienced health risks due to air pollution by medical evidence.

Conclusion

High health risks due to industries and old motor vehicles in the city need to be reduced by introducing policies and strategies for low-carbon, minimizing traveling distance, encouraging high occupancy vehicles, and promoting a green legacy in the street network and green building.

Association between exposure to greenness and atopic march in children and adults-A systematic review and meta-analysis

Introduction

Allergic diseases are a global public health problem. Food allergy, atopic dermatitis (AD), allergic rhinoconjunctivitis, allergic rhinitis (AR) and asthma represent the natural course of allergic diseases, also known as the "atopic march". In recent years, a large number of studies have been published on the association between greenness exposure and allergic diseases. However, systematic reviews on the association between greenness exposure and multiple allergic diseases or atopic march are lacking.

Methods

In this study, PubMed, EMBASE, ISI Web of Science, and Scopus were systematically searched. Meta-analyses were performed if at least three studies reported risk estimates for the same outcome and exposure measures.

Results

Of 2355 records, 48 studies were included for qualitative review. Five birth cohort studies, five cross-sectional studies, and one case-control study were included for asthma meta-analysis, respectively. Four birth cohort studies were included for AR meta-analysis. Our results support that exposure to a greener environment at birth reduces the risk of asthma and AR in childhood. In addition, higher greenness exposure was associated with decreased odds of current asthma in children.

Discussion

There was a large heterogeneity among the included studies and most of them did not specify the vegetation type and causative allergens. Therefore the study results need to be further validated. In addition, a small number of studies evaluated the association between greenness and food allergy, AD and allergic rhinoconjunctivitis. More research is needed to strengthen our understanding of the association between greenness and allergic diseases.

Does childhood exposure to biodiverse greenspace reduce the risk of developing asthma?

The prevalence of inflammatory diseases is increasing in populations throughout the industrialized world. An increasing proportion of human populations grow up and live in urban areas, probably with reduced exposure to biodiversity, including diverse soil biotas. Decreased exposure to microorganisms from natural environments, in particular in early childhood, has been hypothesized to hamper development of the human immune system and lead to increasing risks of inflammatory diseases, such as asthma. We investigated 40,249 Danish individuals born 1995-2015. Percentage greenspace was assessed in a 2 km buffer around home addresses of individuals. The Danish Biodiversity Map, charting occurrence density of red-listed animals, plants and macrofungi, was used as a proxy for multi-taxon biodiversity. For asthma defined broadly, we found no evidence of decreasing risk of developing asthma with higher levels of biodiversity, while greenspace exposure was associated with higher risk of asthma. In contrast, exposure to total and biodiverse greenspace was associated with reduced risk of developing severe asthma. Exposure to farmland, which in Denmark is heavily industrialized cropland, also showed association with elevated risk of developing asthma, even at relatively low agricultural landcover. In the subset of children growing up in highly urbanized settings, we found high exposures to urban greenspace to be associated with reduced risk of developing asthma. Our results lend limited support to the hypothesis that childhood exposure to biodiverse environments reduces the risk of acquiring inflammatory diseases later in life. However, access to urban greenspace, such as parks, which typically harbour low levels of biodiversity, seems to reduce asthma risk, potentially through exposure to common soil microbiota. Our results suggest that effects of biodiversity exposure on human health is set by a balance between ecosystem services and disservices and that biodiversity conservation is best motivated with other arguments than reduction of risks from inflammatory diseases.

Green and blue spaces and lung function in the Generation XXI cohort: a life-course approach

BACKGROUND

Exposure to natural environments may affect respiratory health. This study examined the association of exposure to green and blue spaces with lung function in children, and assessed the mediation effect of air pollution and physical activity.

METHODS

The study used data from the Generation XXI, a population-based birth cohort from the Porto Metropolitan Area (Portugal). Residential Normalised Difference Vegetation Index (NDVI) at different buffers (100, 250 and 500 m), the accessibility to urban green spaces (UGS) within 400 and 800 m and the minimum distance to the nearest UGS and to the nearest blue spaces were assessed at birth, 4, 7 and 10 years of age. Three life-course measures were calculated: averaged exposure, early-life exposure (birth) and exposure trend over time (change in exposure). Forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1) and forced expiratory flow between 25% and 75% of FVC (FEF25-75%) at 10 years were used as outcomes. To assess associations, linear regression models and path analysis were used.

RESULTS

This study included 3278 children. The adjusted models showed that increasing the NDVI exposure over time within 100 m of the child's residence was associated with higher values of FEV1 (L) and FEF25-75% (L·s-1) (β 0.01, 95% CI 0.0002-0.03 and β 0.02, 95% CI 0.001-0.05, respectively). No significant associations were observed for the remaining measures of exposure, and no mediation effect was found for pollution or physical activity.

CONCLUSION

Increasing exposure to greenness at close proximity from residences was associated with improved lung function. While the mechanism remains unknown, this study brings evidence that city greening may improve children's respiratory health.

Time Trends of Greenspaces, Air Pollution, and Asthma Prevalence among Children and Adolescents in India

The prevalence of childhood asthma contributes to the global burden of the disease substantially. Air pollution in India has increased. In this study, we examine the associations among greenspaces, air pollution, and asthma prevalence in children and adolescents over a large, diverse population in India. We used state-wide global burden of disease data on asthma from age 0 to 19 years in 2005, 2011, and 2017. For greenspace, we used the normalized differential vegetation index (NDVI), which is the surface reflectance of light during photosynthetic activity. NDVI, air pollutants (PM_2.5, PM₁₀, SO₂, NO₂, and O₃), weather, and socio-demographic factors were included in generalized estimating equation (GEE) models to estimate their associations with childhood asthma prevalence over time. Novel data visualization illustrated the complex spatial distributions. NDVI was associated with asthma prevalence (β = 0.144; 95% CI = 0.10, 0.186; p < 0.0001) for high PM_2.5, along with high levels of both gaseous air pollutants, SO₂, and NO₂ ((β = 0.12; 95% CI = 0.08, 0.16; p < 0.0001) and (β = 0.09; 95% CI = 0.05, 0.13; p < 0.0001)). However, NDVI and high O₃, had a strong negative association with asthma prevalence (β = -0.19; 95% CI = -0.26, -0.11; p < 0.0001). We observed additional effects of the interaction between the NDVI and high concentrations of PM_2.5, PM₁₀, NO₂, and O₃, assuming that these associations share a common pathway, and found interaction effects for asthma prevalence. Given the changing environmental conditions that interplay over geographical characteristics on the prevalence of asthma, further studies may elucidate a better understanding of these complex associations.

The associations between residential greenness and allergic diseases in Chinese toddlers: A birth cohort study

BACKGROUND

Green space in the living environment has been linked to the development of allergic diseases. However, evidence regarding early-onset allergy in toddlers was limited, and the critical exposure window remained unclear. We aimed to investigate associations between residential greenness with allergic diseases in early life.

METHODS

This prospective birth cohort study included 522 mother-child pairs in Guangzhou, China. We quantified prenatal, postnatal, and early-life (i.e., the first 1000 days of life) residential greenness, estimated from remote satellite data using normalized difference vegetation index (NDVI), enhanced vegetation index (EVI), and tree cover. We identified physician-diagnosed allergic diseases (eczema, atopic dermatitis, urticaria, allergic rhinitis, allergic conjunctivitis, food allergy, and asthma) based on medical records at age 2 years. Generalized linear regression was conducted to examine the associations of greenness with allergic outcomes.

RESULTS

The ranges of residential NDVI and EVI values in 500-m buffer during early life were 0.06-0.70 and 0.03-0.46, respectively. We found a 0.1 unit increase of NDVI in 500-m buffer throughout early life was associated with higher odds of any allergic diseases (prenatal: OR [odds ratio], 1.25; 95%CI, 1.02-1.53; postnatal: OR, 1.24; 95%CI, 1.02-1.52; early-life: OR, 1.25, 95%CI: 1.02-1.53) and higher odds of eczema (prenatal: OR, 1.28; 95%CI, 1.04-1.59; postnatal: OR, 1.24; 95%CI, 1.01-1.54; early-life: OR, 1.26, 95%CI: 1.02-1.56). The results were consistent when using EVI as a proxy for greenness. We only observed that prenatal exposure to the highest tertile of NDVI-500 was adversely associated with any allergic diseases (OR, 1.63; 95%CI, 1.03-2.58) and eczema (OR, 1.70; 95%CI: 1.04-2.78) compared with the lowest tertile.

CONCLUSIONS

This study identified detrimental associations of residential greenness with allergic diseases especially eczema among toddlers, and pregnancy appears to be the critical exposure window. Our findings highlighted the importance of urban planning to develop friendly-green neighborhood to improve maternal and child health.

Effect of preconceptional, prenatal and postnatal exposure to home environmental factors on childhood pneumonia: A key role in early life exposure

BACKGROUND

Increasing evidence have associated pneumonia with early exposure to ambient air pollution. However, the role of indoor environmental factors exposure in early life on childhood pneumonia remains unclear.

OBJECTIVE

To examine the association between indoor environmental factors exposure during different timing windows and childhood pneumonia, and to identify the key indoor factor(s) in different critical window(s).

METHODS

A retrospective cohort study of 8689 pre-schoolers was performed in Changsha, China during 2019-2020. Our questionnaire survey was designed to collect information on pre-schooler's outcome and residential environmental exposure containing indoor pollution and allergens during 1 year before pregnancy, pregnancy, first year, and past year. The associations were further estimated stratified by personal exposure level of outdoor NO₂, CO, temperature (T) and different covariates. Associations were assessed by multiple logistic regression model in terms of odds ratio (OR) of 95% confidence interval (CI).

RESULTS

Pre-schooler's pneumonia was significantly related with exposure of new furniture, redecoration, mold/damp stains, and mold or damp clothing or bedding exposure during the four periods, with the strongest associations observed during 1 year before pregnancy based on multi-window model, with ORs (95% CI) of 1.27 (1.12-1.44), 1.26 (1.09-1.46), 1.34 (1.14-1.57), and 1.28 (1.05-1.56) respectively. Environmental tobacco smoke (ETS) including both parental and grandparental smoking were significantly related with increased risk of pre-schooler's pneumonia, and ETS played a more important role in early life, with ORs (95% CI) of 1.17 (1.01-1.36) and 1.19 (1.02-1.39) in pregnancy and first year. Indoor plants particularly nonflowering plants significantly elevated pneumonia risk but only in past year, with ORs (95% CI) of 1.17 (1.05-1.30) and 1.14 (1.03-1.26). Higher pneumonia risk was observed for renovation exposure in pre-birth compared to post-birth, while mold/dampness exerted an accumulative effect with the highest risk for exposure during both pre- and post-birth. Living near traffic road and exposure to high level of traffic-related air pollution and high temperature significantly increased pneumonia risk. Sensitivity analysis found that some sub-groups were more susceptible to pneumonia risk of home environment exposure.

CONCLUSION

Early life exposure to indoor environmental factors plays an important role in pneumonia development, supporting the hypothesis of "Preconceptional and Fetal Origin of Childhood Pneumonia" and "Developmental Origins of Health and Pneumonia".

Effects of early life exposure to home environmental factors on childhood allergic rhinitis: Modifications by outdoor air pollution and temperature

BACKGROUND

There is growing evidence that allergic rhinitis (AR) is associated with indoor environmental factors, but their role in childhood AR during early life remains unclear.

OBJECTIVE

To investigate the association of preconceptional, prenatal, early postnatal, and current exposure to home environmental factors with childhood AR, and to further explore whether this association can be interacted by outdoor air pollution and temperature.

METHODS

A retrospective cohort study of 8689 preschool children was conducted during 2019-2020 in Changsha, China. A standard questionnaire was used to collect data on each family's health outcomes and home environments. We considered home environmental exposures during one year before conception, pregnancy, first year of life, and past year. Associations of indoor air pollution and allergens with AR were assessed by multiple logistic regression models.

RESULTS

Pre-birth exposure to indoor air pollution emitted by new furniture or redecoration and dampness related allergen derived from mold/damp stains and mold/damp clothes or bedding during 1 year before conception and pregnancy was significantly associated with increased AR, with adjusted ORs (95% CI) ranging from 1.35 (1.05-1.75) to 1.87 (1.55-2.27). Childhood AR was also significantly related with post-birth exposure to dampness related indoor allergen including mold/damp stains and mold/damp clothes or bedding in first year and past year and pollen allergen including total and nonflowing plants in past year, with a range of ORs (95% CI) from 1.20 (1.01-1.42) to 1.79 (1.42-2.27). We identified that pre-birth, particularly in utero exposure to both indoor air pollution from renovation and dampness related allergens, played a key role in AR development compared to post-birth exposures, and accumulative effect was observed with the highest risk of AR. High exposure to traffic-related air pollution (TRAP) including outdoor PM_2.5, NO₂, CO, and O₃, as well as living near traffic road not only significantly increased adverse effect of home environmental factors but also decreased protective effect of household dogs on childhood AR. Early life exposure to low temperature in pregnancy and high temperature in first year significantly increased AR risk of home environmental exposure. Sensitivity analysis indicated that some sub-groups were more susceptible to AR risk of home environmental exposure.

CONCLUSION

Our study suggests that pre-birth exposure to home environmental factors played an important role in AR development and this effect can be interacted by TRAP and temperature, which supports a hypothesis of "(pre)fetal origin of childhood AR".

Spatial heterogeneity in health risks of illness-related absenteeism associated with PM2.5 exposure for elementary students

Little is known about the impact of socio-economic and environmental factors on the associations between PM_2.5 exposure and health risk for elementary students. We estimated the space variability of effects of PM_2.5 on daily illness-related absence rate for 2278 elementary schools from 97 counties across Jiangsu Province with data collected in the 2016-17 academic year. We evaluated the effects at school- and county-scales and examined the role of socio-economic and environmental factors with generalized addictive models (GAM). With an interquartile range (IQR, 32 μg/m³) increase in PM_2.5 concentration, the relative risk of absence rate for a given school ranged between 1.00 and 2.81. Factors including high economic development level, low health expenditure, dense road network, dense population and low vegetation coverage drove strong effects for schools/counties. For the implementation of efficient clean air policies and public health interventions, we should concern about not only high-polluted areas but also areas under specific socio-economic and environmental conditions.

Growing up green: a systematic review of the influence of greenspace on youth development and health outcomes

Youth growing up in places with more greenspaces have better developmental outcomes. The literature on greenspace and youth development is largely cross-sectional, thus limited in terms of measuring development and establishing causal inference. We conducted a systematic review of prospective, longitudinal studies measuring the association between greenspace exposure and youth development outcomes measured between ages two and eighteen. We searched Cochrane, PubMed, CINAHL, Scopus, and Environment Complete, and included prospective cohort, quasi-experimental, and experimental studies on greenspace and youth development. Study quality was assessed using a 10-item checklist adapted from a previously published review on greenspace and health. Twenty-eight studies met criteria for review and were grouped into five thematic categories based on reported outcomes: cognitive and brain development, mental health and wellbeing, attention and behavior, allergy and respiratory, and obesity and weight. Seventy-nine percent of studies suggest an association between greenspace and improved youth development. Most studies were concentrated in wealthy, Western European countries, limiting generalizability of findings. Key opportunities for future research include: (1) improved uniformity of standards in measuring greenspace, (2) improved measures to account for large latency periods between greenspace exposure and developmental outcomes, and (3) more diverse study settings and populations.

Exposure to urban greenspace and pathways to respiratory health: An exploratory systematic review

BACKGROUND/OBJECTIVE

Urban greenspace may have a beneficial or adverse effect on respiratory health. Our objective was to perform an exploratory systematic review to synthesise the evidence and identify the potential causal pathways relating urban greenspace and respiratory health.

METHODS

We followed PRISMA guidelines on systematic reviews and searched five databases for eligible studies during 2000-2021. We incorporated a broad range of urban greenspace and respiratory health search terms, including both observational and experimental studies. Screening, data extraction, and risk of bias, assessed using the Navigation Guide criteria, were performed independently by two authors. We performed a narrative synthesis and discuss suggested pathways to respiratory health.

RESULTS

We identified 108 eligible papers (n = 104 observational, n = 4 experimental). The most common greenspace indicators were the overall greenery or vegetation (also known as greenness), green land use/land cover of physical area classes (e.g., parks, forests), and tree canopy cover. A wide range of respiratory health indicators were studied, with asthma prevalence being the most common. Two thirds (n = 195) of the associations in these studies were positive (i.e., beneficial) with health, with 31% (n = 91) statistically significant; only 9% (n = 25) of reported associations were negative (i.e., adverse) with health and statistically significant. The most consistent positive evidence was apparent for respiratory mortality. There were n = 35 (32%) 'probably low' and n = 73 (68%) 'probably high' overall ratings of bias. Hypothesised causal pathways for health benefits included lower air pollution, more physically active populations, and exposure to microbial diversity; suggested mechanisms with poorer health included exposure to pollen and other aeroallergens.

CONCLUSION

Many studies showed positive association between urban greenspace and respiratory health, especially lower respiratory mortality; this is suggestive, but not conclusive, of causal effects. Results underscore the importance of contextual factors, greenspace metric employed, and the potential bias of subtle selection factors, which should be explored further.

Maternal exposure to PM2.5/BC during pregnancy predisposes children to allergic rhinitis which varies by regions and exclusive breastfeeding

BACKGROUND

Increasing prevalence of childhood allergic rhinitis(AR) needs a deeper understanding on the potential adverse effects of early life exposure to air pollution.

OBJECTIVES

The main aim was to evaluate the effects of maternal exposure to PM_2.5 and chemical constituents during pregnancy on preschool children's AR, and further to explore the modification effects of regions and exclusive breastfeeding.

METHODS

A multi-center population-based study was performed in 6 cities from 3 regions of China in 2011-2012. Maternal exposure to ambient PM_2.5 and main chemical constituents(BC, OM, SO₄^2-, NO₃^-, NH₄⁺) during pregnancy was assessed and a longitudinal prospective analysis was applied on preschool children's AR. The modification effects of regions and exclusive breastfeeding were investigated.

RESULTS

A total of 8.8% and 9.8% of children reported doctor-diagnosed allergic rhinitis(DDAR) and current hay fever, respectively, and 48.6% had less than 6 months of exclusive breastfeeding. The means of PM_2.5 during pregnancy were 52.7 μg/m³, 70.3 μg/m³ and 76.4 μg/m³ in the east, north and central south of China, respectively. Multilevel log-binomial model regression showed that each interquartile range(IQR) increase of PM_2.5 during pregnancy was associated with an average increase in prevalence ratio (PR) of DDAR by 1.43(95% confidence interval(CI): 1.11, 1.84) and current hay fever by 1.79(95% CI: 1.26, 2.55), respectively. Among chemical constituents, black carbon (BC) had the strongest associations. Across 3 regions, the eastern cities had the highest associations, followed by those in the central south and the north. For those equal to or longer than 6 months of exclusive breastfeeding, the associations were significantly reduced.

CONCLUSIONS

Children in east of China had the highest risks of developing AR per unit increase of maternal exposure to PM_2.5 during pregnancy, especially BC constituent. Remarkable decline was found in association with an increase in breastfeeding for ≥6 months, in particular in east of China.

Residential greenness, asthma, and lung function among children at high risk of allergic sensitization: a prospective cohort study

BACKGROUND

While benefits of greenness to health have been reported, findings specific to child respiratory health are inconsistent.

METHODS

We utilized a prospective birth cohort followed from birth to age 7 years (n = 617). Residential surrounding greenness was quantified via Normalized Difference Vegetation Index (NDVI) within 200, 400, and 800 m distances from geocoded home addresses at birth, age 7 years, and across childhood. Respiratory health outcomes were assessed at age 7 years, including asthma and lung function [percent predicted forced expiratory volume in the first second (%FEV₁), percent predicted forced vital capacity (%FVC), and percent predicted ratio of forced expiratory volume in the first second to forced vital capacity (%FEV₁/FVC)]. We assessed associations using linear and logistic regression models adjusted for community deprivation, household income, and traffic-related air pollution. We tested for effect measure modification by atopic status.

RESULTS

We noted evidence of positive confounding as inverse associations were attenuated upon adjustment in the multivariable models. We found evidence of effect measure modification of NDVI and asthma within 400 m at age 7 years by atopic status (p = 0.04), whereby children sensitized to common allergens were more likely to develop asthma as exposure to greenness increased (OR = 1.3, 95% CI: 0.9, 2.0) versus children not sensitized to common allergens (OR = 0.8, 95% CI: 0.5, 1.2). We found consistently positive associations between NDVI and %FEV₁ and %FVC which similarly evidenced positive confounding upon adjustment. In the adjusted regression models, NDVI at 7 years of age was associated with %FEV₁ (200 m: β = 2.1, 95% CI: 0.1, 3.3; 400 m: β = 1.6, 95% CI: 0.3, 2.9) and %FVC (200 m: β = 1.8, 95% CI: 0.7, 3.0; 400 m: β = 1.6, 95% CI: 0.3, 2.8; 800 m: β = 1.5, 95% CI: 0.1, 2.8). Adjusted results for %FEV₁/FVC were non-significant except exposure at birth in the 400 m buffer (β = 0.81, 95% CI: 0.1, 1.5). We found no evidence of effect measure modification of NDVI by atopic status for objective measures of lung function.

CONCLUSION

Sensitivity to allergens may modify the effect of greenness on risk for asthma in children but greenness is likely beneficial for concurrent lung function regardless of allergic status.

Association between residential green cover and direct healthcare costs in Northern California: An individual level analysis of 5 million persons

BACKGROUND AND OBJECTIVE

Prior studies have shown higher green cover levels are associated with beneficial health outcomes. We sought to determine if residential green cover was also associated with direct healthcare costs.

METHODS

We linked residential Normalized Difference Vegetation Index (NDVI) satellite data for 5,189,303 members of Kaiser Permanente Northern California (KPNC) to direct individual healthcare costs for 2003-2015. Using generalized linear regression to adjust for confounding, we examined the association between direct healthcare costs and green cover within250, 500, and 1000 meters (m) of an individual's residence. Costs were determined from an internal cost accounting system that captures administrative and patient care costs for each clinical encounter. Sensitivity analyses included adjustments for comorbidity and an alternative measure of green cover, tree canopy.

RESULTS

We observed a significant inverse association between higher levels of residential green cover and lower direct healthcare costs. The relative rate of total cost for the highest compared to the lowest decile of NDVI was 0.92 (95% CI 0.90-0.93) for the 500 m buffer. The association was robust to adjustment from a broad array of confounders, found at each buffer size, and largely driven by hospitalization, and emergency department visits. Individuals in the top decile of residential green cover had adjusted healthcare costs of $374.04 (95% CI $307.31-$439.41) per person per year less than individuals living in the bottom or least green decile. Sensitivity analyses including tree canopy cover as the green space measure yielded similar findings. Analyses that included adjustment for comorbidity were consistent with the hypothesis that green cover reduces healthcare costs by improving health status.

CONCLUSION

Green cover was associated with lower direct healthcare costs, raising the possibility that residential greening can have a significant healthcare cost impact across the population.

Combined effects of air pollution and extreme heat events among ESKD patients within the Northeastern United States

BACKGROUND

Increasing number of studies have linked air pollution exposure with renal function decline and disease. However, there is a lack of data on its impact among end-stage kidney disease (ESKD) patients and its potential modifying effect from extreme heat events (EHE).

METHODS

Fresenius Kidney Care records from 28 selected northeastern US counties were used to pool daily all-cause mortality (ACM) and all-cause hospital admissions (ACHA) counts. County-level daily ambient PM_2.5 and ozone (O₃) were estimated using a high-resolution spatiotemporal coupled climate-air quality model and matched to ESKD patients based on ZIP codes of treatment sites. We used time-stratified case-crossover analyses to characterize acute exposures using individual and cumulative lag exposures for up to 3 days (Lag 0-3) by using a distributed lag nonlinear model framework. We used a nested model comparison hypothesis test to evaluate for interaction effects between air pollutants and EHE and stratification analyses to estimate effect measures modified by EHE days.

RESULTS

From 2001 to 2016, the sample population consisted of 43,338 ESKD patients. We recorded 5217 deaths and 78,433 hospital admissions. A 10-unit increase in PM_2.5 concentration was associated with a 5% increase in ACM (rate ratio [RR_Lag0-3]: 1.05, 95% CI: 1.00-1.10) and same-day O₃ (RR_Lag0: 1.02, 95% CI: 1.01-1.03) after adjusting for extreme heat exposures. Mortality models suggest evidence of interaction and effect measure modification, though not always simultaneously. ACM risk increased up to 8% when daily ozone concentrations exceeded National Ambient Air Quality Standards established by the United States, but the increases in risk were considerably higher during EHE days across lag periods.

CONCLUSION

Our findings suggest interdependent effects of EHE and air pollution among ESKD patients for all-cause mortality risks. National level assessments are needed to consider the ESKD population as a sensitive population and inform treatment protocols during extreme heat and degraded pollution episodes.

Integration of Aerobiological Information for Construction Engineering Based on LiDAR and BIM

In green urban areas, the allergenic factor is important when selecting trees to improve the quality of life of the population. An application of laser imaging detection and ranging (LiDAR) in building information modelling (BIM) is the capture of geo-referenced geometric information of the environment. This study presents the process of digitalisation of a green infrastructure inventory based on the geolocation and bioparameters of the cypress species. The aerobiological index (IUGZA) was estimated by developing green infrastructure BIM models at different detail levels and with a new BIM dimension (6D) for the urban environment. The novelty of the study is the modelling of urban information for evaluating the potential environmental impact related to the allergenicity of the urban green infrastructure using LiDAR through BIM. The measurements of cypress trees based on bioparameters and distances were applied to the IUGZA. This innovation for describing the current 3D environments and designing new scenarios in 6D may prevent future problems in urban areas during construction projects.

Association between Asthma Control and Exposure to Greenness and Other Outdoor and Indoor Environmental Factors: A Longitudinal Study on a Cohort of Asthmatic Children

Achieving and maintaining asthma control (AC) is the main goal of asthma management. Indoor and outdoor environmental factors may play an important role on AC. The aim of this longitudinal study was to evaluate the association between AC and exposure to greenness and other outdoor or indoor environmental factors in a cohort of asthmatic children. This study involved 179 asthmatic children (5-16 years). Parents were interviewed through a modified version of the SIDRIA questionnaire. AC was assessed at each visit. Exposure to greenness was measured using the normalized difference vegetation index (NDVI). A logistic regression model was applied for assessing risk factors for uncontrolled asthma (UA). Low NDVI exposure was a risk factor for UA (OR: 2.662, 95% CI (1.043-6.799)); children exposed to passive smoke during pregnancy had a higher risk of UA than those non-exposed to passive smoke during pregnancy (OR: 3.816, 95% CI (1.114-13.064)); and a unit increase in the crowding index was associated with an increased risk of UA (OR: 3.376, 95% CI (1.294-8.808)). In conclusion, the current study provided a comprehensive assessment of urban-related environmental exposures on asthma control in children, using multiple indicators of greenness and other outdoor or indoor environmental factors.

Impact of land cover change on urban tree cover and potential regulating ecosystem services: the case of Aydın/Turkey

The availability of urban tree cover (UTC) is one of the most important components of healthy urban environments that support the provision of many ecosystem services. The development in Turkey keeps going within/around urban environments, and the degradation and loss of urban vegetation and associated ecosystem services continues. In this study, we aimed to assess the impacts of land cover change on UTC and ecosystem services provided by them in the case of Efeler District, in Aydın Province of Turkey between 2004 and 2021. The ecosystem services and benefits estimated with the i-Tree Canopy tool includes carbon sequestration and storage as well as the removal of nitrogen dioxide, ozone, sulphur dioxide, PM2.5 and PM10 as well as their economic valuation. Our results show that there was a decline trend in UTC between the years of 2004 and 2021. The loss of UTC was caused by the combined effects of new development pressure in and around the natural/semi-natural and agricultural areas, as well as the new reconstruction sites around old settlements. During the last 17 years, the loss of 61.38 ha UTC created a decrease in the carbon and air pollution benefits and economic valuation estimates. It would be premature to make direct use of our results in planning, without further analysis of the composition and age structure of tree/shrub species. However, the approach used in this study does demonstrate the principle and potential nature of such a methodology where comprehensive analysis are limited by the lack of sufficient data, time and labour.

Associations between trees and grass presence with childhood asthma prevalence using deep learning image segmentation and a novel green view index

Limitations of Normalized Difference Vegetation Index (NDVI) potentially contributed to the inconsistent findings of greenspace exposure and childhood asthma. The aim of this study was to use a novel greenness exposure assessment method, capable of overcoming the limitation of NDVI to determine the extent to which it was associated with asthma prevalence in Chinese children. During 2009-2013, a cross-sectional study of 59,754 children aged 2-17 years was conducted in northeast China. Tencent street view images surrounding participants' schools were segmented by a deep learning model, and streetscape greenness was extracted. The green view index (GVI) was used to assign exposure and higher value indicates more green coverage. Mixed-effects logistic regression models were used to calculate the adjusted odds of asthma per interquartile range (IQR) increase of GVI for trees and grass. Participants were further stratified to investigate whether particulate matter with an aerodynamic diameter <2.5 μm (PM_2.5) was a modifier. An IQR increase in GVI_800m for trees was associated with lower adjusted odds of doctor-diagnosed asthma (OR: 0.76; 95%CI: 0.72-0.80) and current asthma (OR: 0.82; 95%CI: 0.75-0.89). An IQR increase in GVI_800m for grass was associated with higher adjusted odds of doctor-diagnosed asthma (OR: 1.04; 95%CI: 1.00-1.08) and current asthma (OR: 1.08; 95%CI: 1.02-1.14). After stratification by PM_2.5 exposure level, the negative association between trees and asthma, and the positive association between grass and asthma were observed only in low PM_2.5 exposure levels (≤median: 56.23 μg/m³). Our results suggest that types of vegetation may play a role in the association between greenness exposure and childhood asthma. Exposure to trees may reduce the odds of childhood asthma, whereas exposure to grass may increase the odds. Additionally, PM_2.5 may modify the associations of trees and grass with childhood asthma.

Physiological and Psychological Assessments for the Establishment of Evidence-Based Forest Healing Programs

This study aimed to establish a health and medical foundation for forest healing programs and provide a basis for developing an evaluation system for such programs. While the number of visitors to forests and interest in forest healing effects are increasing, few studies have examined the various indicators of the persistent changes in forest healing effects. Therefore, this study conducted pre-, post-, and follow-up experiments on 87 health and clinical indicators in a sample of 88 adolescent participants. The relationships between pre-, post-, and follow-up experiment results for each indicator were analyzed. Of the 87 indicators, 46 showed significant changes, including systolic blood pressure, diastolic blood pressure, cholesterol, serotonin, vitamin D, CD16+CD56 count, interferon-γ, resilience, and self-esteem. The findings are significant for studying diverse participants and indicators and lay the foundation for developing forest healing programs by clarifying aspects such as the indicators suitable for short-term observation versus the indicators requiring long-term observation. Based on these analyses, the results of this study are expected to be useful when conducting research to establish an evidence-based forest healing program in the future.

Green infrastructure can limit but not solve air pollution injustice

Outdoor air pollution contributes to millions of deaths worldwide yet air pollution has differential exposures across racial/ethnic groups and socioeconomic status. While green infrastructure has the potential to decrease air pollution and provide other benefits to human health, vegetation alone cannot resolve health disparities related to air pollution injustice. We discuss how unequal access to green infrastructure can limit air quality improvements for marginalized communities and provide strategies to move forward.

Short term physician visits and medication prescriptions for allergic disease associated with seasonal tree, grass, and weed pollen exposure across the United States

BACKGROUND

While year-round exposure to pollen is linked to a large burden of allergic diseases, location-specific risk information on pollen types and allergy outcomes are limited. We characterize the relationship between acute exposure to tree, grass and weed pollen taxa and two allergy outcomes (allergic rhinitis physician visit and prescription allergy medication fill) across 28 metropolitan statistical areas (MSA) in the United States.

METHODS

We obtained daily pollen data from National Allergy Bureau (NAB) monitors at these 28 MSAs for 2008-2015. We revised the NAB guidelines to classify taxa-specific pollen severity each day. Daily information on allergic rhinitis and prescribed allergy medications for individuals with employer-based health insurance from the IBM MarketScan Research database for these MSAs. We combined the daily pollen and health data for each MSA into a longitudinal dataset. We conducted a MSA-specific conditional quasi-Poisson regression analysis to assess how different levels of pollen concentration impact the health outcomes, controlling for local air pollution, meteorology and Influenza-like illness (ILI). We used a random effects meta-analysis to produce an overall risk estimate for each pollen type and health outcome.

RESULTS

The seasonal distribution of pollen taxa and associated health impacts varied across the MSAs. Relative risk of allergic rhinitis visits increased as concentrations increased for all pollen types; relative risk of medication fills increased for tree and weed pollen only. We observed an increase in health risk even on days with moderate levels of pollen concentration. 7-day average concentration of pollen had stronger association with the health outcomes compared to the same-day measure. Controlling for air pollution and ILI had little impact on effect estimates.

CONCLUSION

This analysis expands the catalogue of associations between different pollen taxa and allergy-related outcomes across multiple MSAs. The effect estimates we present can be used to project the burden of allergic disease in specific locations in the future as well inform patients with allergies on impending pollen exposure.

Allergic symptoms in association with naturalness, greenness, and greyness: A cross-sectional study in schoolchildren in the Alps

BACKGROUND

Greenness may protect from or contribute to allergy risk by influencing air pollution and human-microbe interactions. However, existing research on the issue is heterogeneous and produced conflicting results. Less in known about the effects of greyness. This study investigated the association between different characteristics of residential and school environment and allergic symptoms in schoolchildren.

METHODS

The present cross-sectional survey was undertaken in 2004/2005 among 1251 schoolchildren (8-12 years old) in several alpine valleys in Austria and Italy. Children's mothers completed a questionnaire that asked about allergic symptoms (International Study of Asthma and Allergies in Childhood questionnaire), sociodemographic information, lifestyle, perinatal data, and housing conditions. We constructed four aggregate outcome variables: current asthma symptoms, ever asthma symptoms, ever allergic rhinitis (AR) symptoms, and ever eczema symptoms. We employed well-known greenness and greyness exposure indicators (Normalized Difference Vegetation Index, tree canopy cover, agricultural cover, imperviousness cover, and industrial cover), as well as an alternative naturalness index (Distance to Nature, D2N). Adjusted logistic regressions were used to explore associations between each exposure-outcome pair. Air pollution (NO₂), traffic noise and time spent outdoors were tested as potential mediators in causal mediation analysis.

RESULTS

Decrease in naturalness in a 500-m buffer around the home was associated with higher prevalence of AR symptoms. Associations with asthma symptoms were in the same direction but marginally significant. Residential NDVI and tree cover were marginally associated with lower prevalence of asthma and AR symptoms. Having a domestic garden was associated with lower prevalence of asthma symptoms. School greenness in a 100-m buffer was associated with lower prevalence of AR symptoms. Residential greyness was associated with higher prevalence of AR and asthma symptoms. We observed stronger associations for greenness and greyness in non-movers and in children without a family history of allergies. Mediation by NO₂ and time spent outdoors was present in some of the exposure-outcome pairs.

CONCLUSIONS

Schoolchildren residing in places with lower naturalness and higher greyness may be more likely to have allergic rhinitis and possibly asthma. Considering more comprehensive indicators than greenness and greyness and conducting research in children without a family history of allergic diseases may be key to better understanding who can profit from natural landscapes.

The influence of urban, socio-economic, and eco-environmental aspects on COVID-19 cases, deaths and mortality: A multi-city case in the Atlantic Forest, Brazil

Urban, socio-economic and eco-environmental influences on people's health are widely studied and well-known. Their relation to COVID-19, however, is still a novel research topic. Thus, we investigated if COVID-19 parameters are higher in cities with higher urbanization, worst socio-economic conditions, and less vegetation cover, considering 3,052 municipalities in the Atlantic Forest, Brazil. Brazil is the second country most affected by COVID-19, and the Atlantic Forest is its most urbanized, populous, and deforested region. Indexes were created through multivariate principal components analysis using secondary official data: population, demographic density, absolute built area, and relative built area as urbanization parameters; average per capita income, relative people vulnerable to poverty, illiteracy rate of the population aged 18 or over, and human development index (HDI) as socio-economic parameters; and absolute and relative vegetation cover, absolute and relative forest cover as eco-environmental parameters. These indexes were correlated with absolute and relative confirmed COVID-19 cases, absolute and relative confirmed deaths, and mortality rate via Spearman's and Kendall's coefficients. Strong correlations (>0.50) were found between COVID-19 and urbanization. Socio-economic and eco-environmental aspects, although weaker predictors of COVID-19, presented meaningful relations with the health parameters. This study contributes to the evidence regarding COVID-19 incidence in the Brazilian population.

Geomatics and epidemiology: Associating oxidative stress and greenness in urban areas

Green spaces may benefit human health mainly by mitigating noise and air pollution, promoting physical or social activities and improving mental health. Based on the influence that green space exposure seems to exert on Public Health and using a multidisciplinary approach, we investigated, the association between oxidative stress (OS) and green exposure in children. Overall, 207 subjects (10-13 yrs) living in Torino (NW- Italy) were involved in this study. Each participant provided a urinary sample, used to quantify a reliable OS biomarker (15-F2t-IsoP), and their residence addresses, used for geocoding. Green exposure was characterised by calculating i) the Soil Adjusted Vegetation Index (SAVI) within fixed buffers around each participant's home, using remotely-sensed data; ii) Tree Map accounting for evergreen/broadleaf species; iii) The percentage of green cover (PGC). Significant negative correlation (Pearson's r = -0.758, p < 0.001) between PGC and 15-F2t-IsoP was found. Greater SAVI was associated with lower OS (Pearson's r = -0.717, p < 0.001). Noticeably, evergreens seemed to determine a significant OS reduction compared to broadleaves (slope = -0.12 and -0.02, respectively; Warton-test F = 12.48, p = 0.0011). Finally, a spatial distribution of 15-F2t-IsoP estimates map, overlying with 2011 Census Data on same-aged dwellers of Torino, was generated. Predictive models accounting for green spaces influence on OS can be useful tool derived from geomatic employ in the Public Health field. Future developments of such a multidisciplinary approach should be considered in urban planning and policy-makers decisions to better define priority zones to requalify in urban settings.

Association between Green Space Structure and the Prevalence of Asthma: A Case Study of Toronto

Asthma is a chronic inflammatory disease that can be caused by various factors, such as asthma-related genes, lifestyle, and air pollution, and it can result in adverse impacts on asthmatics' mental health and quality of life. Hence, asthma issues have been widely studied, mainly from demographic, socioeconomic, and genetic perspectives. Although it is becoming increasingly clear that asthma is likely influenced by green spaces, the underlying mechanisms are still unclear and inconsistent. Moreover, green space influences the prevalence of asthma concurrently in multiple ways, but most existing studies have explored only one pathway or a partial pathway, rather than the multi-pathways. Compared to greenness (measured by Normalized Difference Vegetation Index, tree density, etc.), green space structure-which has the potential to impact the concentration of air pollution and microbial diversity-is still less investigated in studies on the influence of green space on asthma. Given this research gap, this research took Toronto, Canada, as a case study to explore the two pathways between green space structure and the prevalence of asthma based on controlling the related covariates. Using regression analysis, it was found that green space structure can protect those aged 0-19 years from a high risk of developing asthma, and this direct protective effect can be enhanced by high tree diversity. For adults, green space structure does not influence the prevalence of asthma unless moderated by tree diversity (a measurement of the richness and diversity of trees). However, this impact was not found in adult females. Moreover, the hypothesis that green space structure influences the prevalence of asthma by reducing air pollution was not confirmed in this study, which can be attributed to a variety of causes.

Strong variations in urban allergenicity riskscapes due to poor knowledge of tree pollen allergenic potential

Exposure to allergenic tree pollen is an increasing environmental health issue in urban areas. However, reliable, well-documented, peer-reviewed data on the allergenicity of pollen from common tree species in urban environments are lacking. Using the concept of 'riskscape', we present and discuss evidence on how different tree pollen allergenicity datasets shape the risk for pollen-allergy sufferers in five cities with different urban forests and population densities: Barcelona, Montreal, New York City, Paris, and Vancouver. We also evaluate how tree diversity can modify the allergenic risk of urban forests. We show that estimates of pollen exposure risk range from 1 to 74% for trees considered to be highly allergenic in the same city. This variation results from differences in the pollen allergenicity datasets, which become more pronounced when a city's canopy is dominated by only a few species and genera. In an increasingly urbanized world, diverse urban forests offer a potentially safer strategy aimed at diluting sources of allergenic pollen until better allergenicity data is developed. Our findings highlight an urgent need for a science-based approach to guide public health and urban forest planning.

Associations between Nature Exposure and Health: A Review of the Evidence

There is extensive empirical literature on the association between exposure to nature and health. In this narrative review, we discuss the strength of evidence from recent (i.e., the last decade) experimental and observational studies on nature exposure and health, highlighting research on children and youth where possible. We found evidence for associations between nature exposure and improved cognitive function, brain activity, blood pressure, mental health, physical activity, and sleep. Results from experimental studies provide evidence of protective effects of exposure to natural environments on mental health outcomes and cognitive function. Cross-sectional observational studies provide evidence of positive associations between nature exposure and increased levels of physical activity and decreased risk of cardiovascular disease, and longitudinal observational studies are beginning to assess long-term effects of nature exposure on depression, anxiety, cognitive function, and chronic disease. Limitations of current knowledge include inconsistent measures of exposure to nature, the impacts of the type and quality of green space, and health effects of duration and frequency of exposure. Future directions include incorporation of more rigorous study designs, investigation of the underlying mechanisms of the association between green space and health, advancement of exposure assessment, and evaluation of sensitive periods in the early life-course.

The Benefits and Limits of Urban Tree Planting for Environmental and Human Health

Many of the world’s major cities have implemented tree planting programs based on assumed environmental and social benefits of urban forests. Recent studies have increasingly tested these assumptions and provide empirical evidence for the contributions of tree planting programs, as well as their feasibility and limits, for solving or mitigating urban environmental and social issues. We propose that current evidence supports local cooling, stormwater absorption, and health benefits of urban trees for local residents. However, the potential for urban trees to appreciably mitigate greenhouse gas emissions and air pollution over a wide array of sites and environmental conditions is limited. Consequently, urban trees appear to be more promising for climate and pollution adaptation strategies than mitigation strategies. In large part, this is due to space constraints limiting the extent of urban tree canopies relative to the current magnitude of emissions. The most promising environmental and health impacts of urban trees are those that can be realized with well-stewarded tree planting and localized design interventions at site to municipal scales. Tree planting at these scales has documented benefits on local climate and health, which can be maximized through targeted site design followed by monitoring, adaptive management, and studies of long-term eco-evolutionary dynamics.

The Contribution of Neighborhood Tree and Greenspace to Asthma Emergency Room Visits: An Application of Advanced Spatial Data in Los Angeles County

This paper aims to investigate the role of neighborhood tree and greenspace on asthma morbidity, especially asthma emergency room visits. We employed advanced spatial data which allow for precisely capturing both the quantity and the features of tree and greenspace within a neighborhood environment. The results from the spatial regression models in Los Angeles County revealed that the features of trees and greenspace, such as the configuration of the tree canopy, the level of tree clustering, and private neighborhood greenspaces contribute to decreasing asthma morbidity, in addition to the quantity of tree and greenspace acreages. Notably, however, large scale greenspace, such as golf courses, school playgrounds, and parks fails to reduce the number of asthma emergency room visits at the statistically significant level. These findings imply that the creation of dense or clustered tree patches and small-scale neighborhood greenspaces might play a substantial role in mitigating air quality and consequently reducing asthma emergency room visits.

Residing near allergenic trees can increase risk of allergies later in life: LISA Leipzig study

BACKGROUND

We investigated whether residing in places with higher greenness, more trees and more allergenic trees early in life increases the risk of allergic outcomes, and whether these associations differ depending on the concentration of air pollutants.

METHODS

The analytic sample included 631 children from the German birth cohort LISA Leipzig. Asthma and allergic rhinitis, sensitization to aeroallergens and food allergens, as well as confounders, were collected prospectively up to 15 years. Greenness was assessed by Normalized Difference Vegetation Index (NDVI). A tree registry was used to derive information on trees, which were classified into allergenic and non-allergenic. Annual average concentrations of nitrogen dioxide (NO₂) and ozone were also used. Geographic exposures were assigned to home addresses at birth. Longitudinal associations were analysed using generalized estimating equations.

RESULTS

Medium and high numbers (tertiles) of trees and allergenic trees in a 500 m buffer around birth addresses were associated with increased odds of allergic rhinitis up to 15 years regardless of NDVI. These exposures were also related to higher odds of sensitization to aeroallergens. Associations with asthma and sensitization to food allergens were less consistent. Effect estimates for allergic rhinitis were stronger in the high tertile of NO₂ compared to the low tertile, while an opposite tendency was observed for ozone.

CONCLUSION

We observed that early life residence in places with many trees, and allergenic trees specifically, may increase the prevalence of allergic rhinitis later in life. This association and its modification by air pollution should be pursued in further studies.

Neighborhood greenness associated with chronic obstructive pulmonary disease: A nationwide cross-sectional study in China

Differential findings have been reported on the association between neighborhood greenness and chronic obstructive pulmonary disease (COPD). The underlying reasons might be the different types of vegetation and the diagnosis methods used in different studies. In this nationwide cross-sectional study in China, we examined the linkage between neighborhood greenness and COPD prevalence among 66,752 adults aged 40 years and above. Neighborhood greenness was estimated using the normalized difference vegetation index (NDVI) based on satellite imagery within buffers of 100, 300, 500, 1000, 2000, 3000 and 5000 m of residential community of the participants. COPD was defined according to the 2017 Global Initiative for Chronic Obstructive Lung Disease lung function criteria. A two-level logistic regression model was applied to estimate the associations. Finally, 9134 adults were classified as COPD. We observed significant positive associations between neighborhood greenness and COPD prevalence. The odds ratio for each interquartile range increase in NDVI within 100 m buffer was 1.08 (95% CI: 1.01, 1.15) after adjustment for potential confounders. Consistent associations were observed across all other NDVI buffer sizes. Stratified analyses revealed that younger adults (40-65 years) and urban residents might be the vulnerable subpopulations. Further regional analyses found that residents from the Northeastern and Northern China were more likely to have this association. Our results indicated that neighborhood greenness might be one risk factor of COPD prevalence. Our study have important public health implications for allocating the surrounding green spaces among living areas, especially for those with respiratory illness; however, the findings and the underlying mechanisms warrant further examinations in longitudinal settings.

Residential green space and medication sales for childhood asthma: A longitudinal ecological study in Belgium

BACKGROUND

Living in green environments has been associated with various health benefits, but the evidence for positive effects on respiratory health in children is ambiguous.

OBJECTIVE

To investigate if residential exposure to different types of green space is associated with childhood asthma prevalence in Belgium.

METHODS

Asthma prevalence was estimated from sales data of reimbursed medication for obstructive airway disease (OAD) prescribed to children between 2010 and 2014, aggregated at census tract level (n = 1872) by sex and age group (6-12 and 13-18 years). Generalized log-linear mixed effects models with repeated measures were used to estimate effects of relative covers of forest, grassland and garden in the census tract of the residence on OAD medication sales. Models were adjusted for air pollution (PM₁₀), housing quality and administrative region.

RESULTS

Consistent associations between OAD medication sales and relative covers of grassland and garden were observed (unadjusted parameter estimates per IQR increase of relative cover, range across four strata: grassland, β = 0.15-0.17; garden, β = 0.13-0.17). The associations remained significant after adjusting for housing quality and chronic air pollution (adjusted parameter estimates per IQR increase of relative cover, range across four strata: grassland, β = 0.10-0.14; garden, β = 0.07-0.09). There was no association between OAD medication sales and forest cover.

CONCLUSIONS

Based on aggregated data, we found that living in close proximity to areas with high grass cover (grasslands, but also residential gardens) may negatively impact child respiratory health. Potential allergic and non-allergic mechanisms that underlie this association include elevated exposure to grass pollen and fungi and reduced exposure to environmental biodiversity. Reducing the dominance of grass in public and private green space might be beneficial to reduce the childhood asthma burden and may simultaneously improve the ecological value of urban green space.

Greenness surrounding schools is associated with lower risk of asthma in schoolchildren

BACKGROUND

There is increasing interest in the effect of residential greenness on respiratory health in children with inconsistent results. However, there are no studies investigating the association between greenness around schools, a representative environment for children and childhood asthma.

OBJECTIVES

To investigate the association between greenness surrounding schools and asthma in schoolchildren.

METHODS

We recruited 59,754 schoolchildren from 94 schools in 2012-2013 from the Seven Northeast Cities Study, China. Greenness surrounding schools was measured using the normalized difference vegetation index (NDVI) and soil adjusted vegetation index (SAVI) at buffers from 30 to 1000 m. Asthma symptoms were collected from validated self-reported questionnaires. Logistic mixed-effects regression models were used to estimate the associations between greenness surrounding school and childhood asthma after adjustment for covariates.

RESULTS

We found that greenness surrounding schools in all buffered sizes was negatively associated with the prevalence of asthmatic symptoms in schoolchildren. A 0.1-unit increase in NDVI_1000m was associated with lower odds of current asthma (odds ratio: 0.81, 95% confidential interval: 0.75, 0.86) and current wheeze (OR: 0.89, 95% CI: 0.84, 0.94) in children after covariate adjustments. Higher greenness was associated with less asthma symptoms in a dose-response pattern (P for trend < 0.05). The estimated associations appeared to be stronger in children exposure to higher air pollution level. The observed associations varied across seven cities.

CONCLUSION

Our findings suggest beneficial associations of greenness surrounding schools with childhood asthma. Further studies are needed to confirm our results.

Pollen production for 13 urban North American tree species: Allometric equations for tree trunk diameter and crown area

Estimates of airborne pollen concentrations at the urban scale would be useful for epidemiologists, land managers, and allergy sufferers. Mechanistic models could be well suited for this task, but their development will require data on pollen production across cities, including estimates of pollen production by individual trees. In this study, we developed predictive models for pollen production as a function of trunk size, canopy area, and height, which are commonly recorded in tree surveys or readily extracted from remote sensing data. Pollen production was estimated by measuring the number of flowers per tree, the number of anthers per flower, and the number of pollen grains per anther. Variability at each morphological scale was assessed using bootstrapping. Pollen production was estimated for the following species: Acer negundo, Acer platanoides, Acer rubrum, Acer saccharinum, Betula papyrifera, Gleditsia triacanthos, Juglans nigra, Morus alba, Platanus x acerfolia, Populus deltoides, Quercus palustris, Quercus rubra, and Ulmus americana. Basal area predicted pollen production with a mean R2 of 0.72 (range: 0.41 - 0.99), whereas canopy area predicted pollen production with a mean R2 of 0.76 (range: 0.50 - 0.99). These equations are applied to two tree datasets to estimate total municipal pollen production and the spatial distribution of street tree pollen production for the focal species. We present some of the first individual-tree based estimates of pollen production at the municipal scale; the observed spatial heterogeneity in pollen production is substantial and can feasibly be included in mechanistic models of airborne pollen at fine spatial scales.