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Stowell JD, Sun Y, Gause EL, Spangler KR, Schwartz J, Bernstein A, Wellenius GA, Nori-Sarma A. Warm season ambient ozone and children's health in the USA. Int J Epidemiol 2024; 53:dyae035. [PMID: 38553030 PMCID: PMC10980558 DOI: 10.1093/ije/dyae035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 02/15/2024] [Indexed: 04/02/2024] Open
Abstract
BACKGROUND Over 120 million people in the USA live in areas with unsafe ozone (O3) levels. Studies among adults have linked exposure to worse lung function and higher risk of asthma and chronic obstructive pulmonary disease (COPD). However, few studies have examined the effects of O3 in children, and existing studies are limited in terms of their geographic scope or outcomes considered. METHODS We leveraged a dataset of encounters at 42 US children's hospitals from 2004-2015. We used a one-stage case-crossover design to quantify the association between daily maximum 8-hour O3 in the county in which the hospital is located and risk of emergency department (ED) visits for any cause and for respiratory disorders, asthma, respiratory infections, allergies and ear disorders. RESULTS Approximately 28 million visits were available during this period. Per 10 ppb increase, warm-season (May through September) O3 levels over the past three days were associated with higher risk of ED visits for all causes (risk ratio [RR]: 0.3% [95% confidence interval (CI): 0.2%, 0.4%]), allergies (4.1% [2.5%, 5.7%]), ear disorders (0.8% [0.3%, 1.3%]) and asthma (1.3% [0.8%, 1.9%]). When restricting to levels below the current regulatory standard (70 ppb), O3 was still associated with risk of ED visits for all-cause, allergies, ear disorders and asthma. Stratified analyses suggest that the risk of O3-related all-cause ED visits may be higher in older children. CONCLUSIONS Results from this national study extend prior research on the impacts of daily O3 on children's health and reinforce the presence of important adverse health impacts even at levels below the current regulatory standard in the USA.
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Affiliation(s)
- Jennifer D Stowell
- Department of Environmental Health, Boston University School of Public Health, Boston, MA, USA
| | - Yuantong Sun
- Department of Environmental Health, Boston University School of Public Health, Boston, MA, USA
| | - Emma L Gause
- Department of Environmental Health, Boston University School of Public Health, Boston, MA, USA
| | - Keith R Spangler
- Department of Environmental Health, Boston University School of Public Health, Boston, MA, USA
| | - Joel Schwartz
- Department of Environmental Health, Harvard TH Chan School of Public Health Boston, MA, USA
| | - Aaron Bernstein
- Division of General Pediatrics, Boston Children's Hospital, Boston, MA, USA
| | - Gregory A Wellenius
- Department of Environmental Health, Boston University School of Public Health, Boston, MA, USA
| | - Amruta Nori-Sarma
- Department of Environmental Health, Boston University School of Public Health, Boston, MA, USA
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Stowell JD, Anenberg S, Zaitchik BF, Tong DQ, Horwell CJ, Stolle DP, Colwell RR, McEntee C. Health-Damaging Climate Events Highlight the Need for Interdisciplinary, Engaged Research. Geohealth 2024; 8:e2024GH001022. [PMID: 38371354 PMCID: PMC10870074 DOI: 10.1029/2024gh001022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 02/06/2024] [Accepted: 02/06/2024] [Indexed: 02/20/2024]
Abstract
In 2023 human populations experienced multiple record-breaking climate events, with widespread impacts on human health and well-being. These events include extreme heat domes, drought, severe storms, flooding, and wildfires. Due to inherent lags in the climate system, we can expect such extremes to continue for multiple decades after reaching net zero carbon emissions. Unfortunately, despite these significant current and future impacts, funding for research in climate and health has lagged behind that for other geoscience and biomedical research. While some initial efforts from funding agencies are evident, there is still a significant need to increase the resources available for multidisciplinary research in the face of this issue. As a group of experts at this important intersection, we call for a more concerted effort to encourage interdisciplinary and policy-relevant investigations into the detrimental health effects of continued climate change.
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3
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Romanello M, Napoli CD, Green C, Kennard H, Lampard P, Scamman D, Walawender M, Ali Z, Ameli N, Ayeb-Karlsson S, Beggs PJ, Belesova K, Berrang Ford L, Bowen K, Cai W, Callaghan M, Campbell-Lendrum D, Chambers J, Cross TJ, van Daalen KR, Dalin C, Dasandi N, Dasgupta S, Davies M, Dominguez-Salas P, Dubrow R, Ebi KL, Eckelman M, Ekins P, Freyberg C, Gasparyan O, Gordon-Strachan G, Graham H, Gunther SH, Hamilton I, Hang Y, Hänninen R, Hartinger S, He K, Heidecke J, Hess JJ, Hsu SC, Jamart L, Jankin S, Jay O, Kelman I, Kiesewetter G, Kinney P, Kniveton D, Kouznetsov R, Larosa F, Lee JKW, Lemke B, Liu Y, Liu Z, Lott M, Lotto Batista M, Lowe R, Odhiambo Sewe M, Martinez-Urtaza J, Maslin M, McAllister L, McMichael C, Mi Z, Milner J, Minor K, Minx JC, Mohajeri N, Momen NC, Moradi-Lakeh M, Morrissey K, Munzert S, Murray KA, Neville T, Nilsson M, Obradovich N, O'Hare MB, Oliveira C, Oreszczyn T, Otto M, Owfi F, Pearman O, Pega F, Pershing A, Rabbaniha M, Rickman J, Robinson EJZ, Rocklöv J, Salas RN, Semenza JC, Sherman JD, Shumake-Guillemot J, Silbert G, Sofiev M, Springmann M, Stowell JD, Tabatabaei M, Taylor J, Thompson R, Tonne C, Treskova M, Trinanes JA, Wagner F, Warnecke L, Whitcombe H, Winning M, Wyns A, Yglesias-González M, Zhang S, Zhang Y, Zhu Q, Gong P, Montgomery H, Costello A. The 2023 report of the Lancet Countdown on health and climate change: the imperative for a health-centred response in a world facing irreversible harms. Lancet 2023; 402:2346-2394. [PMID: 37977174 DOI: 10.1016/s0140-6736(23)01859-7] [Citation(s) in RCA: 30] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 08/07/2023] [Accepted: 08/31/2023] [Indexed: 11/19/2023]
Affiliation(s)
- Marina Romanello
- Institute for Global Health, University College London, London, UK.
| | - Claudia di Napoli
- School of Agriculture, Policy and Development, University of Reading, Reading, UK
| | - Carole Green
- Department of Global Health, University of Washington, Washington, DC, USA
| | - Harry Kennard
- Center on Global Energy Policy, Columbia University, New York, NY, USA
| | - Pete Lampard
- Department of Health Sciences, University of York, York, UK
| | - Daniel Scamman
- Institute for Sustainable Resources, University College London, London, UK
| | - Maria Walawender
- Institute for Global Health, University College London, London, UK
| | - Zakari Ali
- Medical Research Council Unit The Gambia, London School of Hygiene and Tropical Medicine, London, UK
| | - Nadia Ameli
- Institute for Sustainable Resources, University College London, London, UK
| | - Sonja Ayeb-Karlsson
- Institute for Risk and Disaster Reduction, University College London, London, UK
| | - Paul J Beggs
- School of Natural Sciences, Macquarie University, Sydney, NSW, Australia
| | | | | | - Kathryn Bowen
- School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Wenjia Cai
- Department of Earth System Science, Tsinghua University, Beijing, China
| | - Max Callaghan
- Mercator Research Institute on Global Commons and Climate Change, Berlin, Germany
| | - Diarmid Campbell-Lendrum
- Department of Environment, Climate Change and Health, World Health Organisation, Geneva, Switzerland
| | - Jonathan Chambers
- Institute for Environmental Sciences, University of Geneva, Geneva, Switzerland
| | - Troy J Cross
- Heat and Health Research Incubator, University of Sydney, Sydney, NSW, Australia
| | | | - Carole Dalin
- Institute for Sustainable Resources, University College London, London, UK
| | - Niheer Dasandi
- International Development Department, University of Birmingham, Birmingham, UK
| | - Shouro Dasgupta
- Euro-Mediterranean Center on Climate Change Foundation, Lecce, Italy
| | - Michael Davies
- Institute for Risk and Disaster Reduction, University College London, London, UK
| | | | - Robert Dubrow
- School of Public Health, Yale University, New Haven, CT, USA
| | - Kristie L Ebi
- Department of Global Health, University of Washington, Washington, DC, USA
| | - Matthew Eckelman
- Department of Civil & Environmental Engineering, Northeastern University, Boston, MA, USA
| | - Paul Ekins
- Institute for Sustainable Resources, University College London, London, UK
| | - Chris Freyberg
- Department of Information Systems, Massey University, Palmerston North, New Zealand
| | - Olga Gasparyan
- Department of Political Science, Florida State University, Tallahassee, FL, USA
| | | | - Hilary Graham
- Department of Health Sciences, University of York, York, UK
| | - Samuel H Gunther
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Ian Hamilton
- Energy Institute, University College London, London, UK
| | - Yun Hang
- Gangarosa Department of Environmental Health, Emory University, Atlanta, GA
| | | | - Stella Hartinger
- Carlos Vidal Layseca School of Public Health and Management, Cayetano Heredia Pervuvian University, Lima, Peru
| | - Kehan He
- Bartlett School of Sustainable Construction, University College London, London, UK
| | - Julian Heidecke
- Interdisciplinary Center for Scientific Computing, Heidelberg University, Heidelberg, Germany
| | - Jeremy J Hess
- Centre for Health and the Global Environment, University of Washington, Washington, DC, USA
| | - Shih-Che Hsu
- Energy Institute, University College London, London, UK
| | - Louis Jamart
- Institute for Global Health, University College London, London, UK
| | - Slava Jankin
- Centre for AI in Government, University of Birmingham, Birmingham, UK
| | - Ollie Jay
- Heat and Health Research Incubator, University of Sydney, Sydney, NSW, Australia
| | - Ilan Kelman
- Institute for Global Health, University College London, London, UK
| | - Gregor Kiesewetter
- International Institute for Applied Systems Analysis Energy, Climate, and Environment Program, Laxenburg, Austria
| | - Patrick Kinney
- Department of Environmental Health, Boston University, Boston, MA, USA
| | - Dominic Kniveton
- School of Global Studies, University of Sussex, Brighton and Hove, UK
| | | | - Francesca Larosa
- Engineering Mechanics, KTH Royal Institute of Technology, Stockholm, Sweden
| | - Jason K W Lee
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Bruno Lemke
- School of Health, Nelson Marlborough Institute of Technology, Nelson, New Zealand
| | - Yang Liu
- Gangarosa Department of Environmental Health, Emory University, Atlanta, GA
| | - Zhao Liu
- Department of Earth System Science, Tsinghua University, Beijing, China
| | - Melissa Lott
- Center on Global Energy Policy, Columbia University, New York, NY, USA
| | | | - Rachel Lowe
- Catalan Institution for Research and Advanced Studies, Barcelona, Spain
| | | | - Jaime Martinez-Urtaza
- Department of Genetics and Microbiology, Autonomous University of Barcelona, Bellaterra, Spain
| | - Mark Maslin
- Department of Geography, University College London, London, UK
| | - Lucy McAllister
- Environmental Studies Program, Denison University, Granville, OH, USA
| | - Celia McMichael
- School of Geography, Earth and Atmospheric Sciences, The University of Melbourne, Melbourne, VIC, Australia
| | - Zhifu Mi
- Bartlett School of Sustainable Construction, University College London, London, UK
| | - James Milner
- Department of Public Health Environments and Society, London School of Hygiene and Tropical Medicine, London, UK
| | - Kelton Minor
- Data Science Institute, Columbia University, New York, NY, USA
| | - Jan C Minx
- Mercator Research Institute on Global Commons and Climate Change, Berlin, Germany
| | - Nahid Mohajeri
- Bartlett School of Sustainable Construction, University College London, London, UK
| | - Natalie C Momen
- Department of Environment, Climate Change and Health, World Health Organisation, Geneva, Switzerland
| | - Maziar Moradi-Lakeh
- Preventive Medicine and Public Health Research Center, Psychosocial Health Research Institute, Department of Community and Family Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Karyn Morrissey
- Department of Technology Management and Economics, Technical University of Denmark, Kongens Lyngby, Denmark
| | | | - Kris A Murray
- Medical Research Council Unit The Gambia, London School of Hygiene and Tropical Medicine, London, UK
| | - Tara Neville
- Department of Environment, Climate Change and Health, World Health Organisation, Geneva, Switzerland
| | - Maria Nilsson
- Department for Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | | | - Megan B O'Hare
- Institute for Global Health, University College London, London, UK
| | - Camile Oliveira
- Institute for Global Health, University College London, London, UK
| | | | - Matthias Otto
- School of Health, Nelson Marlborough Institute of Technology, Nelson, New Zealand
| | - Fereidoon Owfi
- Iranian Fisheries Science Research Institute, Tehran, Iran
| | - Olivia Pearman
- Center for Science and Technology Policy, University of Colorado Boulder, Boulder, CO, USA
| | - Frank Pega
- Department of Environment, Climate Change and Health, World Health Organisation, Geneva, Switzerland
| | | | | | - Jamie Rickman
- Institute for Sustainable Resources, University College London, London, UK
| | - Elizabeth J Z Robinson
- Grantham Research Institute on Climate Change and the Environment, London School of Economics and Political Science, London, UK
| | - Joacim Rocklöv
- Interdisciplinary Center for Scientific Computing, Heidelberg University, Heidelberg, Germany
| | - Renee N Salas
- Harvard Medical School, Harvard University, Boston, MA, USA
| | - Jan C Semenza
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Jodi D Sherman
- Department of Anesthesiology, Yale University, New Haven, CT, USA
| | | | - Grant Silbert
- Melbourne Medical School, The University of Melbourne, Melbourne, VIC, Australia
| | | | - Marco Springmann
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | | | - Meisam Tabatabaei
- Institute of Tropical Aquaculture and Fisheries, Universiti Malaysia Terengganu, Terengganu, Malaysia
| | - Jonathon Taylor
- Department of Civil Engineering, Tampere University, Tampere, Finland
| | | | - Cathryn Tonne
- Barcelona Institute for Global Health, Barcelona, Spain
| | - Marina Treskova
- Interdisciplinary Center for Scientific Computing, Heidelberg University, Heidelberg, Germany
| | - Joaquin A Trinanes
- Department of Electronics and Computer Science, University of Santiago de Compostela, Santiago, Spain
| | - Fabian Wagner
- International Institute for Applied Systems Analysis Energy, Climate, and Environment Program, Laxenburg, Austria
| | - Laura Warnecke
- International Institute for Applied Systems Analysis Energy, Climate, and Environment Program, Laxenburg, Austria
| | - Hannah Whitcombe
- Institute for Global Health, University College London, London, UK
| | - Matthew Winning
- Institute for Sustainable Resources, University College London, London, UK
| | - Arthur Wyns
- Melbourne Climate Futures, The University of Melbourne, Melbourne, VIC, Australia
| | - Marisol Yglesias-González
- Centro Latinoamericano de Excelencia en Cambio Climatico y Salud, Cayetano Heredia Pervuvian University, Lima, Peru
| | - Shihui Zhang
- Department of Earth System Science, Tsinghua University, Beijing, China
| | - Ying Zhang
- School of Public Health, University of Sydney, Sydney, NSW, Australia
| | - Qiao Zhu
- Gangarosa Department of Environmental Health, Emory University, Atlanta, GA
| | - Peng Gong
- Department of Geography, University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Hugh Montgomery
- Department of Experimental and Translational Medicine and Division of Medicine, University College London, London, UK
| | - Anthony Costello
- Institute for Global Health, University College London, London, UK
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4
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Stowell JD, Ngo C, Jimenez MP, Kinney PL, James P. Development of a global urban greenness indicator dataset for 1,000+ cities. Data Brief 2023; 48:109140. [PMID: 37069950 PMCID: PMC10088350 DOI: 10.1016/j.dib.2023.109140] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 03/29/2023] [Accepted: 04/03/2023] [Indexed: 04/19/2023] Open
Abstract
Global climate change has sparked efforts to adapt to increasing temperatures, especially in urban areas that experience increased day and nighttime temperatures due to the urban heat island effect. The addition of greenspace has been suggested as a possible means for urban centers to respond to increasing urban temperatures. Thus, it is important for urban planning and policymakers to have access to data on greenspace specific at a fine spatial resolution. This dataset consists of information on peak and annual average 1 × 1 km Normalized Difference Vegetation Index (NDVI) for over 1,000 global urban centers, which is an objective satellite-based measure of vegetation. Population-weighted values for both peak and annual average NDVI and include an indicator of greenness, with seven levels ranging from extremely low to extremely high are provided. Additional information regarding the climate zone (using the Köppen-Geiger climate classification) and level of development (using the Human Development Index or HDI) for each city is included. Analyses were repeated in 2010, 2015, and 2020 to provide the ability to track urban greenness over time. Data are provided in tabular format with summaries presented in both tables and graphics. These data can be used to inform policy and planning and can be used as an indicator for a variety of climate and health investigations.
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Affiliation(s)
- Jennifer D. Stowell
- Department of Environmental Health, Boston University School of Public Health, 715 Albany Street, Boston, MA 02118, United States
| | - Catherine Ngo
- Consultant, Boston University School of Public Health, 715 Albany Street, Boston, MA 02118, United States
| | - Marcia Pescador Jimenez
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, 715 Albany Street, Boston, MA 02118, United States
| | - Patrick L. Kinney
- Department of Environmental Health, Boston University School of Public Health, 715 Albany Street, Boston, MA 02118, United States
| | - Peter James
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, Landmark Center, 401 Park Dr #401, Boston, MA 02215, United States
- Department of Environmental Health, Harvard T. Chan School of Public Health, 677 Huntington Avenue, Boston, MA 02115, United States
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5
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Stowell JD, Sun Y, Spangler KR, Milando CW, Bernstein A, Weinberger KR, Sun S, Wellenius GA. Warm-season temperatures and emergency department visits among children with health insurance. Environ Res Health 2023; 1:015002. [PMID: 36337257 PMCID: PMC9623446 DOI: 10.1088/2752-5309/ac78fa] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 05/17/2022] [Accepted: 06/15/2022] [Indexed: 01/25/2023]
Abstract
High ambient temperatures have become more likely due to climate change and are linked to higher rates of heat-related illness, respiratory and cardiovascular diseases, mental health disorders, and other diseases. To date, far fewer studies have examined the effects of high temperatures on children versus adults, and studies including children have seldom been conducted on a national scale. Compared to adults, children have behavioral and physiological differences that may give them differential heat vulnerability. We acquired medical claims data from a large database of commercially insured US children aged 0-17 from May to September (warm-season) 2016-2019. Daily maximum ambient temperature and daily mean relative humidity estimates were aggregated to the county level using the Parameter-elevation Relationships on Independent Slopes dataset, and extreme heat was defined as the 95th percentile of the county-specific daily maximum temperature distribution. Using a case-crossover design and temperature lags 0-5 days, we estimated the associations between extreme heat and cause-specific emergency department visits (ED) in children aged <18 years, using the median county-specific daily maximum temperature distribution as the reference. Approximately 1.2 million ED visits in children from 2489 US counties were available during the study period. The 95th percentile of warm-season temperatures ranged from 71 °F to 112 °F (21.7 °C to 44.4 °C). Comparing 95th to the 50th percentile, extreme heat was associated with higher rates of ED visits for heat-related illness; endocrine, nutritional and metabolic diseases; and otitis media and externa, but not for all-cause admissions. Subgroup analyses suggested differences by age, with extreme heat positively associated with heat-related illness for both the 6-12 year (odds ratio [OR]: 1.34, 95% confidence interval [CI]: 1.16, 1.56) and 13-17 year age groups (OR: 1.55, 95% CI: 1.37, 1.76). Among children with health insurance across the US, days of extreme heat were associated with higher rates of healthcare utilization. These results highlight the importance of individual and population-level actions to protect children and adolescents from extreme heat, particularly in the context of continued climate change.
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Affiliation(s)
- Jennifer D Stowell
- Department of Environmental Health, Boston University School of Public Health, Boston, MA, United States of America
| | - Yuantong Sun
- Department of Environmental Health, Boston University School of Public Health, Boston, MA, United States of America
| | - Keith R Spangler
- Department of Environmental Health, Boston University School of Public Health, Boston, MA, United States of America
| | - Chad W Milando
- Department of Environmental Health, Boston University School of Public Health, Boston, MA, United States of America
- Optum Labs Visiting Scholar, Eden Prairie, MN, United States of America
| | - Aaron Bernstein
- Boston Children’s Hospital, Boston, MA, United States of America
| | - Kate R Weinberger
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Shengzhi Sun
- Department of Environmental Health, Boston University School of Public Health, Boston, MA, United States of America
- Optum Labs Visiting Scholar, Eden Prairie, MN, United States of America
| | - Gregory A Wellenius
- Department of Environmental Health, Boston University School of Public Health, Boston, MA, United States of America
- Optum Labs Visiting Scholar, Eden Prairie, MN, United States of America
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6
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Heaney A, Stowell JD, Liu JC, Basu R, Marlier M, Kinney P. Impacts of Fine Particulate Matter From Wildfire Smoke on Respiratory and Cardiovascular Health in California. Geohealth 2022; 6:e2021GH000578. [PMID: 35795228 PMCID: PMC9166629 DOI: 10.1029/2021gh000578] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 05/13/2022] [Accepted: 05/19/2022] [Indexed: 05/26/2023]
Abstract
Increases in wildfire activity across the Western US pose a significant public health threat. While there is evidence that wildfire smoke is detrimental for respiratory health, the impacts on cardiovascular health remain unclear. This study evaluates the association between fine particulate matter (PM2.5) from wildfire smoke and unscheduled cardiorespiratory hospital visits in California during the 2004-2009 wildfire seasons. We estimate daily mean wildfire-specific PM2.5 with Goddard Earth Observing System-Chem, a global three-dimensional model of atmospheric chemistry, with wildfire emissions estimates from the Global Fire Emissions Database. We defined a "smoke event day" as cumulative 0-1-day lag wildfire-specific PM2.5 ≥ 98th percentile of cumulative 0-1 lag day wildfire PM2.5. Associations between exposure and outcomes are estimated using negative binomial regression. Results indicate that smoke event days are associated with a 3.3% (95% CI: [0.4%, 6.3%]) increase in visits for all respiratory diseases and a 10.3% (95% CI: [2.3%, 19.0%]) increase for asthma specifically. Stratifying by age, we found the largest effect for asthma among children ages 0-5 years. We observed no significant association between exposure and overall cardiovascular disease, but stratified analyses revealed increases in visits for all cardiovascular, ischemic heart disease, and heart failure among non-Hispanic white individuals and those older than 65 years. Further, we found a significant interaction between smoke event days and daily average temperature for all cardiovascular disease visits, suggesting that days with high wildfire PM2.5 concentrations and high temperatures may pose greater risk for cardiovascular disease. These results suggest substantial increases in adverse outcomes from wildfire smoke exposure and indicate the need for improved prevention strategies and adaptations to protect vulnerable populations.
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Affiliation(s)
- Alexandra Heaney
- Division of Environmental Health SciencesSchool of Public HealthUniversity of California, BerkeleyBerkeleyCAUSA
| | - Jennifer D. Stowell
- Department of Environmental HealthSchool of Public HealthBoston UniversityBostonMAUSA
| | | | - Rupa Basu
- California Office of Environmental Health Hazard AssessmentAir and Climate Epidemiology SectionOaklandCAUSA
| | - Miriam Marlier
- Department of Environmental Health SciencesUniversity of California, Los AngelesLos AngelesCAUSA
| | - Patrick Kinney
- Department of Environmental HealthSchool of Public HealthBoston UniversityBostonMAUSA
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7
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Gorris ME, Anenberg SC, Goldberg DL, Kerr GH, Stowell JD, Tong D, Zaitchik BF. Shaping the Future of Science: COVID-19 Highlighting the Importance of GeoHealth. Geohealth 2021; 5:e2021GH000412. [PMID: 34084984 PMCID: PMC8144838 DOI: 10.1029/2021gh000412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 04/26/2021] [Accepted: 05/02/2021] [Indexed: 06/12/2023]
Abstract
From the heated debates over the airborne transmission of the novel coronavirus to the abrupt Earth system changes caused by the sudden lockdowns, the dire circumstances resulting from the coronavirus disease 2019 (COVID-19) pandemic have brought the field of GeoHealth to the forefront of visibility in science and policy. The pandemic has inadvertently provided an opportunity to study how human response has impacted the Earth system, how the Earth system may impact the pandemic, and the capacity of GeoHealth to inform real-time policy. The lessons learned throughout our responses to the COVID-19 pandemic are shaping the future of GeoHealth.
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Affiliation(s)
- Morgan E. Gorris
- Information Systems and ModelingLos Alamos National LaboratoryLos AlamosNMUSA
| | - Susan C. Anenberg
- Department of Environmental and Occupational HealthMilken Institute School of Public HealthGeorge Washington UniversityWashingtonDCUSA
| | - Daniel L. Goldberg
- Department of Environmental and Occupational HealthMilken Institute School of Public HealthGeorge Washington UniversityWashingtonDCUSA
| | - Gaige Hunter Kerr
- Department of Environmental and Occupational HealthMilken Institute School of Public HealthGeorge Washington UniversityWashingtonDCUSA
| | - Jennifer D. Stowell
- Department of Environmental HealthBoston University School of Public HealthBostonMAUSA
| | - Daniel Tong
- Department of Atmospheric, Oceanic, & Earth SciencesGeorge Mason UniversityFairfaxVAUSA
| | - Benjamin F. Zaitchik
- Department of Earth and Planetary SciencesJohns Hopkins UniversityBaltimoreMDUSA
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8
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Zaitchik BF, Sweijd N, Shumake-Guillemot J, Morse A, Gordon C, Marty A, Trtanj J, Luterbacher J, Botai J, Behera S, Lu Y, Olwoch J, Takahashi K, Stowell JD, Rodó X. A framework for research linking weather, climate and COVID-19. Nat Commun 2020; 11:5730. [PMID: 33184283 PMCID: PMC7661498 DOI: 10.1038/s41467-020-19546-7] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 10/21/2020] [Indexed: 01/06/2023] Open
Abstract
Early studies of weather, seasonality, and environmental influences on COVID-19 have yielded inconsistent and confusing results. To provide policy-makers and the public with meaningful and actionable environmentally-informed COVID-19 risk estimates, the research community must meet robust methodological and communication standards.
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Affiliation(s)
- Benjamin F Zaitchik
- Department of Earth and Planetary Sciences, Johns Hopkins University, 3400N. Charles St., Baltimore, MD, 21218, USA.
| | - Neville Sweijd
- Alliance for Collaboration on Climate and Earth Systems Science (ACCESS) c/o Council for Scientific and Industrial Research (CSIR), 15 Lower Hope Road, Cape Town, 7700, South Africa
| | - Joy Shumake-Guillemot
- WHO/WMO Climate and Health Joint Office, World Meteorological Organization, 7bis Avenue de la Paix, C.P. 2300, CH-1211, Geneva, Switzerland
| | - Andy Morse
- School of Environmental Sciences, University of Liverpool, Liverpool, L69 7BX, UK
| | - Chris Gordon
- CDKN CEL-Ghana and Institute for Environment and Sanitation Studies, College of Basic and Applied Sciences, University of Ghana, Legon, Accra, Ghana
| | - Aileen Marty
- Herbert Wertheim College of Medicine, 11200 SW 8th St, AHC2 675, Miami, FL, 33199, USA
| | - Juli Trtanj
- Climate Program Office, National Oceanic and Atmospheric Administration, 1315 East-West Highway Suite 100, Silver Spring, MD, 20910, USA
| | - Juerg Luterbacher
- Science and Innovation Department, World Meteorological Organization, 7bis Avenue de la Paix, C.P. 2300, CH-1211, Geneva, Switzerland
| | - Joel Botai
- South African Weather Service, 01 Ecopark Drive, Ecoglades Block B, Centurion, Pretoria, 0157, South Africa
| | | | - Yonglong Lu
- Key Laboratory of the Ministry of Education for Coastal Wetland Ecosystems, College of the Environment and Ecology, Xiamen University, 361102, Fujian, China
| | - Jane Olwoch
- SASSCAL Regional Secretariat, 28 Robert Mugabe Avenue, Windhoek, Namibia
| | - Ken Takahashi
- Servicio Nacional de Meteorología e Hidrología del Perú-SENAMHI, Jr. Cahuide 785, Jesús María, Lima, 15072, Peru
| | - Jennifer D Stowell
- Boston University, 715 Albany Street, The Talbot Building, T4W, Boston, MA, 02118, USA
| | - Xavier Rodó
- ICREA and Climate and Health Program, ISGlobal, Doctor Aiguader 88, Barcelona, 08003, Barcelona, Spain
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Stowell JD, Geng G, Saikawa E, Chang HH, Fu J, Yang CE, Zhu Q, Liu Y, Strickland MJ. Associations of wildfire smoke PM 2.5 exposure with cardiorespiratory events in Colorado 2011-2014. Environ Int 2019; 133:105151. [PMID: 31520956 PMCID: PMC8163094 DOI: 10.1016/j.envint.2019.105151] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 08/26/2019] [Accepted: 09/02/2019] [Indexed: 05/04/2023]
Abstract
BACKGROUND Substantial increases in wildfire activity have been recorded in recent decades. Wildfires influence the chemical composition and concentration of particulate matter ≤2.5 μm in aerodynamic diameter (PM2.5). However, relatively few epidemiologic studies focus on the health impacts of wildfire smoke PM2.5 compared with the number of studies focusing on total PM2.5 exposure. OBJECTIVES We estimated the associations between cardiorespiratory acute events and exposure to smoke PM2.5 in Colorado using a novel exposure model to separate smoke PM2.5 from background ambient PM2.5 levels. METHODS We obtained emergency department visits and hospitalizations for acute cardiorespiratory outcomes from Colorado for May-August 2011-2014, geocoded to a 4 km geographic grid. Combining ground measurements, chemical transport models, and remote sensing data, we estimated smoke PM2.5 and non-smoke PM2.5 on a 1 km spatial grid and aggregated to match the resolution of the health data. Time-stratified, case-crossover models were fit using conditional logistic regression to estimate associations between fire smoke PM2.5 and non-smoke PM2.5 for overall and age-stratified outcomes using 2-day averaging windows for cardiovascular disease and 3-day windows for respiratory disease. RESULTS Per 1 μg/m3 increase in fire smoke PM2.5, statistically significant associations were observed for asthma (OR = 1.081 (1.058, 1.105)) and combined respiratory disease (OR = 1.021 (1.012, 1.031)). No significant relationships were evident for cardiovascular diseases and smoke PM2.5. Associations with non-smoke PM2.5 were null for all outcomes. Positive age-specific associations related to smoke PM2.5 were observed for asthma and combined respiratory disease in children, and for asthma, bronchitis, COPD, and combined respiratory disease in adults. No significant associations were found in older adults. DISCUSSION This is the first multi-year, high-resolution epidemiologic study to incorporate statistical and chemical transport modeling methods to estimate PM2.5 exposure due to wildfires. Our results allow for a more precise assessment of the population health impact of wildfire-related PM2.5 exposure in a changing climate.
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Affiliation(s)
- Jennifer D Stowell
- Department of Environmental Health, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA 30322, USA
| | - Guannan Geng
- Department of Environmental Health, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA 30322, USA
| | - Eri Saikawa
- Department of Environmental Health, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA 30322, USA; Department of Environmental Sciences, Emory University, 201 Dowman Drive, Mailstop 1131-002-1AA, Atlanta, GA 30322, USA
| | - Howard H Chang
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA 30322, USA
| | - Joshua Fu
- Department of Civil and Environmental Engineering, University of Tennessee Knoxville, 851 Neyland Drive, Knoxville, TN 37996, USA
| | - Cheng-En Yang
- Department of Civil and Environmental Engineering, University of Tennessee Knoxville, 851 Neyland Drive, Knoxville, TN 37996, USA
| | - Qingzhao Zhu
- Department of Civil and Environmental Engineering, University of Tennessee Knoxville, 851 Neyland Drive, Knoxville, TN 37996, USA
| | - Yang Liu
- Department of Environmental Health, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA 30322, USA.
| | - Matthew J Strickland
- School of Community Health Sciences, University of Nevada Reno, 1664 N. Virginia Street, Reno, NV 89557, USA.
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Buyken AE, Mela DJ, Dussort P, Johnson IT, Macdonald IA, Stowell JD, Brouns FJPH. Dietary carbohydrates: a review of international recommendations and the methods used to derive them. Eur J Clin Nutr 2018; 72:1625-1643. [PMID: 29572552 PMCID: PMC6281563 DOI: 10.1038/s41430-017-0035-4] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Revised: 09/18/2017] [Accepted: 10/05/2017] [Indexed: 12/21/2022]
Abstract
BACKGROUND/OBJECTIVES Renewed dietary recommendations for carbohydrates have recently been published by various international health authorities. The present work (1) reviews the methods and processes (systematic approach/review, inclusion of public consultation) used to identify, select and grade the evidence underpinning the recommendations, particularly for total carbohydrate (CHO), fibre and sugar consumption, and (2) examines the extent to which variation in the methods and processes applied relates to any differences in the final recommendations. SUBJECTS/METHODS A search of WHO, US, Canada, Australia and European sources identified 19 documents from 13 authorities with the desired detailed information. Processes and methods applied to derive recommendations were compiled and compared. RESULTS (1) A relatively high total CHO and fibre intake and limited intake of (added or free) sugars are generally recommended. (2) Even where recommendations are similar, the specific justifications for quantitative/qualitative recommendations differ across authorities. (3) Differences in recommendations mainly arise from differences in the underlying definitions of CHO exposure and classifications, the degree to which specific CHO-providing foods and food components were considered, and the choice and number of health outcomes selected. (4) Differences in the selection of source material, time frames or data aggregation and grading methods appeared to have minor influence. CONCLUSIONS Despite general consistency, apparent differences among the recommendations of different authorities would likely be minimized by: (1) More explicit quantitative justifications for numerical recommendations and communication of uncertainty, and (2) greater international harmonization, particularly in the underlying definitions of exposures and range of relevant nutrition-related outcomes.
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Affiliation(s)
- A E Buyken
- Institute of Nutrition, Consumption and Health, Faculty of Natural Sciences, University Paderborn, Paderborn, Germany
- DONALD Study Dortmund, Department of Nutritional Epidemiology, University of Bonn, Bonn, Germany
| | - D J Mela
- Unilever R&D Vlaardingen, Vlaardingen, The Netherlands
| | - P Dussort
- International Life Sciences Institute-ILSI Europe a.i.s.b.l., Avenue E. Mounier 83, Box 6, Brussels, Belgium.
| | - I T Johnson
- Quadram Institute Bioscience, Norwich Research Park, Norfolk, NR4 7UA, UK
| | - I A Macdonald
- School of Life Sciences, Queen's Medical Centre, University of Nottingham, Nottingham, UK
| | - J D Stowell
- DuPont Nutrition & Health, Danisco Ltd, Reigate, UK
| | - F J P H Brouns
- Faculty of Health, Medicine and Life Sciences, Department of Human Biology, Maastricht University, Maastricht, The Netherlands
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11
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Amin MM, Stowell JD, Hendley W, Garcia P, Schmid DS, Cannon MJ, Dollard SC. CMV on surfaces in homes with young children: results of PCR and viral culture testing. BMC Infect Dis 2018; 18:391. [PMID: 30103693 PMCID: PMC6088405 DOI: 10.1186/s12879-018-3318-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Accepted: 08/07/2018] [Indexed: 11/23/2022] Open
Abstract
Background Caring for young children is a known risk factor for cytomegalovirus (CMV) infection mainly through exposure to their saliva and urine. In a previous study, 36 CMV-seropositive children 2 mo. to 4 years old were categorized as CMV shedders (n = 23) or non-shedders (n = 13) based on detection of CMV DNA in their saliva and urine. The current study evaluated the presence of CMV on surfaces in homes of the children. Methods Study staff made 4 visits to homes of the 36 enrolled children over 100 days. Saliva was collected by swabbing the mouth and urine was collected on filter paper inserted into diapers. In addition, five surface specimens were collected: three in contact with children’s saliva (spoon, child’s cheek, washcloth) and two in contact with children’s urine (diaper changing table, mother’s hand). Samples were tested by PCR and viral culture to quantify the presence of CMV DNA and viable virus. Results A total of 654 surface samples from 36 homes were tested; 136 were CMV DNA positive, 122 of which (90%) were in homes of the children shedding CMV (p < 0.001). Saliva–associated samples were more often CMV positive with higher viral loads than urine-associated samples. The higher the CMV viral load of the child in the home, the more home surfaces that were PCR positive (p = 0.01) and viral culture positive (p = 0.05). Conclusions The main source for CMV on surfaces in homes was saliva from the child in the home. Higher CMV viral loads shed by children correlated with more viable virus on surfaces which could potentially contribute to viral transmission.
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Affiliation(s)
- Minal M Amin
- Centers for Disease Control and Prevention (CDC), 1600 Clifton Road NE, Atlanta, GA, 30329, USA
| | | | - William Hendley
- Centers for Disease Control and Prevention (CDC), 1600 Clifton Road NE, Atlanta, GA, 30329, USA
| | - Philip Garcia
- Centers for Disease Control and Prevention (CDC), 1600 Clifton Road NE, Atlanta, GA, 30329, USA
| | - D Scott Schmid
- Centers for Disease Control and Prevention (CDC), 1600 Clifton Road NE, Atlanta, GA, 30329, USA
| | - Michael J Cannon
- Centers for Disease Control and Prevention (CDC), 1600 Clifton Road NE, Atlanta, GA, 30329, USA
| | - Sheila C Dollard
- Centers for Disease Control and Prevention (CDC), 1600 Clifton Road NE, Atlanta, GA, 30329, USA.
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12
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Levis DM, Hillard CL, Price SM, Reed-Gross E, Bonilla E, Amin M, Stowell JD, Clark R, Johnson D, Mask K, Carpentieri C, Cannon MJ. Using theory-based messages to motivate U.S. pregnant women to prevent cytomegalovirus infection: results from formative research. BMC Womens Health 2017; 17:131. [PMID: 29237429 PMCID: PMC5729419 DOI: 10.1186/s12905-017-0482-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Accepted: 11/28/2017] [Indexed: 11/10/2022]
Abstract
BACKGROUND An estimated 1 in 150 infants is born each year with congenital cytomegalovirus (CMV); nearly 1 in 750 suffers permanent disabilities. Congenital CMV is the result of a pregnant woman becoming infected with CMV. Educating pregnant women about CMV is currently the best approach to prevention. Limited research is available on how to effectively communicate with women about CMV. We conducted formative research on fear appeals theory-based messages about CMV and prevention with U.S. women. Fear appeal theories suggest that message recipients will take action if they feel fear. METHODS First, we conducted in-depth interviews (N = 32) with women who had young children who tested positive for CMV. Second, we conducted eight focus groups (N = 70) in two phases and two cities (Phase 2: Atlanta, GA; Phase 3: San Diego, CA) with pregnant women and non-pregnant women who had young children. Few participants knew about CMV before the focus groups. Participants reviewed and gave feedback on messages created around fear appeals theory-based communication concepts. The following concepts were tested in one or more of the three phases of research: CMV is severe, CMV is common, CMV is preventable, CMV preventive strategies are similar to other behavior changes women make during pregnancy, CMV preventive strategies can be incorporated in moderation to reduce exposure, and CMV is severe but preventable. RESULTS Participants recommended communicating that CMV is common by using prevalence ratios (e.g., 1 in 150) or comparing CMV to other well-known disabilities. To convey the severity of CMV, participants preferred stories about CMV along with prevention strategies. Participants also welcomed prevention strategies when it included a message about risk reduction. In general, participants said messages were motivating, even if they felt that it could be difficult to make certain behavior changes. CONCLUSIONS Findings from this research can contribute to future efforts to educate pregnant women about CMV, especially regarding use of fear appeals-based messages. Pregnant women may face certain challenges to practicing prevention strategies but, overall, are motivated make changes to increase their chances of having a healthy baby.
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Affiliation(s)
- Denise M Levis
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention (CDC), 1600 Clifton Road, Mailstop E-86, Atlanta, GA, 30333, USA.
| | - Christina L Hillard
- Carter Consulting, Inc., 2310 Parklake Drive NE, Suite 535, Atlanta, GA, 30345, USA
| | - Simani M Price
- Westat, Inc., 1600 Research Blvd, Rockville, MD, 20850, USA
| | | | - Erika Bonilla
- Westat, Inc., 1600 Research Blvd, Rockville, MD, 20850, USA
| | - Minal Amin
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention (CDC), 1600 Clifton Road, Mailstop G-18, Atlanta, GA, 30333, USA
| | - Jennifer D Stowell
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention (CDC), 1600 Clifton Road, Mailstop E-86, Atlanta, GA, 30333, USA
| | - Rebekah Clark
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention (CDC), 1600 Clifton Road, Mailstop E-86, Atlanta, GA, 30333, USA
| | - Delaney Johnson
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention (CDC), 1600 Clifton Road, Mailstop E-86, Atlanta, GA, 30333, USA
| | - Karen Mask
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention (CDC), 1600 Clifton Road, Mailstop E-86, Atlanta, GA, 30333, USA
| | - Cynthia Carpentieri
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention (CDC), 1600 Clifton Road, Mailstop E-86, Atlanta, GA, 30333, USA
| | - Michael J Cannon
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention (CDC), 1600 Clifton Road, Mailstop E-86, Atlanta, GA, 30333, USA
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13
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Stowell JD, Kim YM, Gao Y, Fu JS, Chang HH, Liu Y. The impact of climate change and emissions control on future ozone levels: Implications for human health. Environ Int 2017; 108:41-50. [PMID: 28800413 PMCID: PMC8166453 DOI: 10.1016/j.envint.2017.08.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Revised: 08/01/2017] [Accepted: 08/01/2017] [Indexed: 05/17/2023]
Abstract
Overwhelming evidence has shown that, from the Industrial Revolution to the present, human activities influence ground-level ozone (O3) concentrations. Past studies demonstrate links between O3 exposure and health. However, knowledge gaps remain in our understanding concerning the impacts of climate change mitigation policies on O3 concentrations and health. Using a hybrid downscaling approach, we evaluated the separate impact of climate change and emission control policies on O3 levels and associated excess mortality in the US in the 2050s under two Representative Concentration Pathways (RCPs). We show that, by the 2050s, under RCP4.5, increased O3 levels due to combined climate change and emission control policies, could contribute to an increase of approximately 50 premature deaths annually nationwide in the US. The biggest impact, however, is seen under RCP8.5, where rises in O3 concentrations are expected to result in over 2,200 additional premature deaths annually. The largest increases in O3 are seen in RCP8.5 in the Northeast, the Southeast, the Central, and the West regions of the US. Additionally, when O3 increases are examined by climate change and emissions contributions separately, the benefits of emissions mitigation efforts may significantly outweigh the effects of climate change mitigation policies on O3-related mortality.
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Affiliation(s)
- Jennifer D Stowell
- Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Young-Min Kim
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Yang Gao
- College of Environmental Science and Engineering, Ocean University of China, Qingdao, Shandong, China
| | - Joshua S Fu
- Department of Civil and Environmental Engineering, University of Tennessee, Knoxville, TN, United States
| | - Howard H Chang
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Yang Liu
- Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, United States.
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14
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Cannon MJ, Stowell JD, Clark R, Dollard PR, Johnson D, Mask K, Stover C, Wu K, Amin M, Hendley W, Guo J, Schmid DS, Dollard SC. Repeated measures study of weekly and daily cytomegalovirus shedding patterns in saliva and urine of healthy cytomegalovirus-seropositive children. BMC Infect Dis 2014; 14:569. [PMID: 25391640 PMCID: PMC4240830 DOI: 10.1186/s12879-014-0569-1] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2014] [Accepted: 10/16/2014] [Indexed: 11/30/2022] Open
Abstract
Background To better understand potential transmission risks from contact with the body fluids of children, we monitored the presence and amount of CMV shedding over time in healthy CMV-seropositive children. Methods Through screening we identified 36 children from the Atlanta, Georgia area who were CMV-seropositive, including 23 who were shedding CMV at the time of screening. Each child received 12 weekly in-home visits at which field workers collected saliva and urine. During the final two weeks, parents also collected saliva and urine daily. Results Prevalence of shedding was highly correlated with initial shedding status: children shedding at the screening visit had CMV DNA in 84% of follow-up saliva specimens (455/543) and 28% of follow-up urine specimens (151/539); those not shedding at the screening visit had CMV DNA in 16% of follow-up saliva specimens (47/303) and 5% of follow-up urine specimens (16/305). Among positive specimens we found median viral loads of 82,900 copies/mL in saliva and 34,730 copies/mL in urine (P = 0.01), while the viral load for the 75th percentile was nearly 1.5 million copies/mL for saliva compared to 86,800 copies/mL for urine. Younger age was significantly associated with higher viral loads, especially for saliva (P < 0.001). Shedding prevalence and viral loads were relatively stable over time. All children who were shedding at the screening visit were still shedding at least some days during weeks 11 and 12, and median and mean viral loads did not change substantially over time. Conclusions Healthy CMV-seropositive children can shed CMV for months at high, relatively stable levels. These data suggest that behavioral prevention messages need to address transmission via both saliva and urine, but also need to be informed by the potentially higher risks posed by saliva and by exposures to younger children. Electronic supplementary material The online version of this article (doi:10.1186/s12879-014-0569-1) contains supplementary material, which is available to authorized users.
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15
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Stowell JD, Mask K, Amin M, Clark R, Levis D, Hendley W, Lanzieri TM, Dollard SC, Cannon MJ. Cross-sectional study of cytomegalovirus shedding and immunological markers among seropositive children and their mothers. BMC Infect Dis 2014; 14:568. [PMID: 25388365 PMCID: PMC4236433 DOI: 10.1186/s12879-014-0568-2] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2014] [Accepted: 10/16/2014] [Indexed: 11/18/2022] Open
Abstract
Background Congenital cytomegalovirus (CMV) is the leading infectious cause of birth defects in the United States. To better understand factors that may influence CMV transmission risk, we compared viral and immunological factors in healthy children and their mothers. Methods We screened for CMV IgG antibodies in a convenience sample of 161 children aged 0-47 months from the Atlanta, Georgia metropolitan area, along with 32 mothers of children who screened CMV-seropositive. We assessed CMV shedding via PCR using saliva collected with oral swabs (children and mothers) and urine collected from diapers using filter paper inserts (children only). Results CMV IgG was present in 31% (50/161) of the children. Half (25/50) of seropositive children were shedding in at least one fluid. The proportion of seropositive children who shed in saliva was 100% (8/8) among the 4-12 month-olds, 64% (9/14) among 13-24 month-olds, and 40% (6/15) among 25-47 month-olds (P for trend = 0.003). Seropositive mothers had a lower proportion of saliva shedding (21% [6/29]) than children (P < 0.001). Among children who were shedding CMV, viral loads in saliva were significantly higher in younger children (P <0.001); on average, the saliva viral load of infants (i.e., <12 months) was approximately 300 times that of two year-olds (i.e., 24-35 months). Median CMV viral loads were similar in children's saliva and urine but were 10-50 times higher (P < 0.001) than the median viral load of the mothers' saliva. However, very high viral loads (> one million copies/mL) were only found in children's saliva (31% of those shedding); children's urine and mothers' saliva specimens all had fewer than 100,000 copies/mL. Low IgG avidity, a marker of primary infection, was associated with younger age (p = 0.03), higher viral loads in saliva (p = 0.02), and lower antibody titers (p = 0.005). Conclusions Young CMV seropositive children, especially those less than one year-old may present high-risk CMV exposures to pregnant women, especially via saliva, though further research is needed to see if this finding can be generalized across racial or other demographic strata. Electronic supplementary material The online version of this article (doi:10.1186/s12879-014-0568-2) contains supplementary material, which is available to authorized users.
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16
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Stowell JD, Forlin-Passoni D, Din E, Radford K, Brown D, White A, Bate SL, Dollard SC, Bialek SR, Cannon MJ, Schmid DS. Cytomegalovirus survival on common environmental surfaces: opportunities for viral transmission. J Infect Dis 2011; 205:211-4. [PMID: 22116837 DOI: 10.1093/infdis/jir722] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Congenital cytomegalovirus (CMV) affects ~1 of 150 births and is a leading cause of hearing loss and intellectual disability. It has been suggested that transmission may occur via contaminated surfaces. CMV AD169 in filtered human saliva, applied to environmental surfaces, was recovered at various time points. Samples were evaluated by culture and real-time polymerase chain reaction. CMV was found viable on metal and wood to 1 hour, glass and plastic to 3 hours, and rubber, cloth, and cracker to 6 hours. CMV was cultured from 83 of 90 wet and 5 of 40 dry surfaces. CMV was more likely to be isolated from wet, highly absorbent surfaces at earlier time points.
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Affiliation(s)
- Jennifer D Stowell
- Division of Viral Disease, National Center for Immunization and Respiratory Disease, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA
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