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Lai PS, Lam NL, Gallery B, Lee AG, Adair-Rohani H, Alexander D, Balakrishnan K, Bisaga I, Chafe ZA, Clasen T, Díaz-Artiga A, Grieshop A, Harrison K, Hartinger SM, Jack D, Kaali S, Lydston M, Mortimer KM, Nicolaou L, Obonyo E, Okello G, Olopade C, Pillarisetti A, Pinto AN, Rosenthal JP, Schluger N, Shi X, Thompson C, Thompson LM, Volckens J, Williams KN, Balmes J, Checkley W, Ozoh OB. Household Air Pollution Interventions to Improve Health in Low- and Middle-Income Countries: An Official American Thoracic Society Research Statement. Am J Respir Crit Care Med 2024; 209:909-927. [PMID: 38619436 DOI: 10.1164/rccm.202402-0398st] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/16/2024] Open
Abstract
Background: An estimated 3 billion people, largely in low- and middle-income countries, rely on unclean fuels for cooking, heating, and lighting to meet household energy needs. The resulting exposure to household air pollution (HAP) is a leading cause of pneumonia, chronic lung disease, and other adverse health effects. In the last decade, randomized controlled trials of clean cooking interventions to reduce HAP have been conducted. We aim to provide guidance on how to interpret the findings of these trials and how they should inform policy makers and practitioners.Methods: We assembled a multidisciplinary working group of international researchers, public health practitioners, and policymakers with expertise in household air pollution from within academia, the American Thoracic Society, funders, nongovernmental organizations, and global organizations, including the World Bank and the World Health Organization. We performed a literature search, convened four sessions via web conference, and developed consensus conclusions and recommendations via the Delphi method.Results: The committee reached consensus on 14 conclusions and recommendations. Although some trials using cleaner-burning biomass stoves or cleaner-cooking fuels have reduced HAP exposure, the committee was divided (with 55% saying no and 45% saying yes) on whether the studied interventions improved measured health outcomes.Conclusions: HAP is associated with adverse health effects in observational studies. However, it remains unclear which household energy interventions reduce exposure, improve health, can be scaled, and are sustainable. Researchers should engage with policy makers and practitioners working to scale cleaner energy solutions to understand and address their information needs.
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Lu W, Jenny A, Romero C, Diaz-Artiga A, Kuster A, Canuz E, Pillarisetti A, McCracken JP, Huang W, Smith KR, Balmes J, Thompson LM. Biomass smoke exposure and somatic growth among children: The RESPIRE and CRECER prospective cohort studies in rural Guatemala. Environ Int 2024; 183:108401. [PMID: 38147790 DOI: 10.1016/j.envint.2023.108401] [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] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 12/11/2023] [Accepted: 12/20/2023] [Indexed: 12/28/2023]
Abstract
BACKGROUND Cooking-related biomass smoke is a major source of household air pollution (HAP) and an important health hazard. Prior studies identified associations between HAP exposure and childhood stunting; less is known for underweight and wasting. Few studies had personal HAP measurements. METHODS 557 households in rural Guatemala were enrolled in the CRECER study, the follow-up study of the RESPIRE randomized intervention trial. They were assigned to three groups that received chimney stoves at different ages of the study children. Multiple personal carbon monoxide (CO) exposure measurements were used as proxies for HAP exposures. Children's heights and weights were measured from 24 to 60 months of age. Height-for-age z-score (HAZ), weight-for-age z-score (WAZ), and weight-for-height z-score (WHZ) were calculated based on the World Health Organization's Multicentre Growth Reference Study. HAZ, WAZ, and WHZ below -2 were classified as stunting, underweight, and wasting, respectively. Generalized linear models and mixed effects models were applied. RESULTS 541 children had valid anthropometric data, among whom 488 (90.2 %) were stunted, 192 (35.5 %) were underweight, and 2 (0.3 %) were wasted. A 1 ppm higher average CO exposure was associated with a 0.21 lower HAZ (95 % CI: 0.17-0.25), a 0.13 lower WAZ (95 % CI: 0.10-0.17) and a 0.06 lower WHZ (95 % CI: 0.02-0.10).The associations for HAZ were stronger among boys (coefficient = -0.29, 95 % CI: -0.35 - -0.22) than among girls (coefficient = -0.15, 95 % CI: -0.20 - -0.10). A 1 ppm-year higher cumulative CO exposure was associated with a higher risk of moderate stunting among boys (OR = 1.27, 95 % CI: 1.05-1.59), but not among girls. DISCUSSION In this rural Guatemalan population, higher HAP exposure was associated with lower HAZ and WAZ. The associations between HAP and HAZ/stunting were stronger among boys. Reducing HAP might benefit childhood somatic growth in rural populations of low-income countries.
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Affiliation(s)
- Wenxin Lu
- School of Public Health, University of California, Berkeley, 94720 Berkeley, CA, USA.
| | - Alisa Jenny
- Institute for Global Health Sciences, University of California, San Francisco, 94158 San Francisco, CA, USA.
| | - Carolina Romero
- Centro de Estudios en Salud, Universidad del Valle de Guatemala, Guatemala City, Guatemala.
| | - Anaite Diaz-Artiga
- Centro de Estudios en Salud, Universidad del Valle de Guatemala, Guatemala City, Guatemala.
| | - Andrea Kuster
- School of Nursing, University of California, San Francisco, 94158 San Francisco, CA, USA.
| | - Eduardo Canuz
- Centro de Estudios en Salud, Universidad del Valle de Guatemala, Guatemala City, Guatemala.
| | - Ajay Pillarisetti
- School of Public Health, University of California, Berkeley, 94720 Berkeley, CA, USA.
| | - John P McCracken
- Epidemiology and Biostatistics Department, University of Georgia, 30606 Athens, GA, USA.
| | - Wenzhong Huang
- Climate, Air Quality Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.
| | - Kirk R Smith
- School of Public Health, University of California, Berkeley, 94720 Berkeley, CA, USA
| | - John Balmes
- School of Public Health, University of California, Berkeley, 94720 Berkeley, CA, USA; Department of Medicine, University of California, San Francisco, San Francisco, CA, USA.
| | - Lisa M Thompson
- Nell Hodgson Woodruff School of Nursing, Emory University, 30322 Atlanta, GA, USA.
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Rosser F, Balmes J. Ozone and childhood respiratory health: A primer for US pediatric providers and a call for a more protective standard. Pediatr Pulmonol 2023; 58:1355-1366. [PMID: 36815617 PMCID: PMC10121852 DOI: 10.1002/ppul.26368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 01/30/2023] [Accepted: 02/17/2023] [Indexed: 02/24/2023]
Abstract
Ground level ozone is a potent respiratory toxicant with decades of accumulated data demonstrating respiratory harms to children. Despite the ubiquity of ozone in the United States, impacting both urban and rural communities, the associated harms of exposure to this important air pollutant are often infrequently or inadequately covered during medical training including pulmonary specialization. Thus, many providers caring for children's respiratory health may have limited knowledge of the harms which may result in reduced discussion of ozone pollution during clinical encounters. Further, the current US air quality standard for ozone does not adequately protect children. In this nonsystematic review, we present basic background information for healthcare providers caring for children's respiratory health, review the US process for setting air quality standards, discuss the respiratory harms of ozone for healthy children and those with underlying respiratory disease, highlight the urgent need for a more protective ozone standard to adequately protect children's respiratory health, review impacts of climate change on ozone levels, and provide information for discussion in clinical encounters.
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Affiliation(s)
- Franziska Rosser
- Department of Pediatrics, Division of Pulmonary Medicine, University of Pittsburgh, School of Medicine, Pittsburgh, PA
| | - John Balmes
- Department of Medicine, University of California, San Francisco, San Francisco, CA
- School of Public Health, University of California, Berkeley, CA
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Bhakta NR, Bime C, Kaminsky DA, McCormack MC, Thakur N, Stanojevic S, Baugh AD, Braun L, Lovinsky-Desir S, Adamson R, Witonsky J, Wise RA, Levy SD, Brown R, Forno E, Cohen RT, Johnson M, Balmes J, Mageto Y, Lee CT, Masekela R, Weiner DJ, Irvin CG, Swenson ER, Rosenfeld M, Schwartzstein RM, Agrawal A, Neptune E, Wisnivesky JP, Ortega VE, Burney P. Race and Ethnicity in Pulmonary Function Test Interpretation: An Official American Thoracic Society Statement. Am J Respir Crit Care Med 2023; 207:978-995. [PMID: 36973004 PMCID: PMC10112445 DOI: 10.1164/rccm.202302-0310st] [Citation(s) in RCA: 62] [Impact Index Per Article: 62.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023] Open
Abstract
Current American Thoracic Society (ATS) standards promote the use of racial/ethnic-specific reference equations for pulmonary function test (PFT) interpretation. There is rising concern that the use of race/ethnicity in PFT interpretation contributes to a false view of fixed differences between races and may mask the effects of differential exposures. This use of race/ethnicity may contribute to health disparities by norming differences in pulmonary function. In the United States, race serves as a social construct that is based on appearance and reflects social values, structures, and practices. Classification of people into racial/ethnic groups differs geographically and temporally. These considerations challenge the notion that racial/ethnic categories have biological meaning and question the use of race in PFT interpretation. The ATS convened a diverse group of clinicians and investigators for a workshop to evaluate the use of race/ethnicity in PFT interpretation. Review of evidence published since then that challenges current practice and continued discussion concluded with a recommendation to replace race/ethnicity-specific equations with race-neutral average reference equations, which must be accompanied with broader re-evaluation of how PFTs are used to make clinical/employment/insurance decisions. There was also a call to engage key stakeholders not represented in this workshop and a statement of caution regarding the uncertain effects and potential harms of this change. Other recommendations include continued research and education to understand the impact of the change, to improve the evidence for the use of PFTs in general, and to identify modifiable risk factors for reduced pulmonary function.
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Affiliation(s)
- Nirav R Bhakta
- University of California San Francisco, 8785, San Francisco, California, United States;
| | - Christian Bime
- University of Arizona, Medicine, Tucson, Arizona, United States
| | - David A Kaminsky
- University of Vermont College of Medicine, 12352, Pulmonary and Critical Care, Burlington, Vermont, United States
| | - Meredith C McCormack
- Johns Hopkins University, Pulmonary and Critical Care, Baltimore, Maryland, United States
| | - Neeta Thakur
- University of California, San Francisco, Medicine, San Francisco, California, United States
| | - Sanja Stanojevic
- Research Insititute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Aaron D Baugh
- UCSF, Division of Pulmonary and Critical Care Medicine, Department of Medicine and CVRI, San Francisco, California, United States
| | - Lundy Braun
- Brown University, 6752, Department of African Studies, Department of Pathology and Laboratory Medicine, Science and Technology Program, Providence, Rhode Island, United States
| | | | - Rosemary Adamson
- University of Washington, Division of Pulmonary, Critical Care & Sleep Medicine, Seattle, Washington, United States
- VA Puget Sound Health Care System, Section of Pulmonary, Critical Care & Sleep Medicine, Seattle, Washington, United States
| | - Jonathan Witonsky
- University of California, San Francisco, San Francisco, California, United States
- United States
| | - Robert A Wise
- Johns Hopkins University School of Medicine, Medicine, Baltimore, Maryland, United States
| | - Sean D Levy
- Beth Israel Deaconess Medical Center, 1859, Pulmonary, Critical Care, & Sleep Medicine, Boston, Massachusetts, United States
| | - Robert Brown
- Massachusetts General Hospital and Harvard Medical School, Pulmonary and Critical Care Division, Department of Medicine, Boston, Massachusetts, United States
| | - Erick Forno
- Children's Hospital of Pittsburgh, Pediatric Pulmonary, Pittsburgh, Pennsylvania, United States
| | - Robyn T Cohen
- Boston University School of Medicine, Pediatrics, Boston, Massachusetts, United States
| | - Meshell Johnson
- UCSF, Medicine-VAMC, San Francisco, California, United States
| | - John Balmes
- University of California, Berkeley, Environmental Health Sciences, School of Public Health, Berkeley, California, United States
- University of California, San Francisco, Department of Medicine, San Francisco, California, United States
| | - Yolanda Mageto
- Baylor Scott and White North Texas, 10616, Dallas, Texas, United States
| | - Cathryn T Lee
- University of Chicago, Department of Medicine, Section of Pulmonary and Critical Care, Chicago, Illinois, United States
| | - Refiloe Masekela
- University of Pretoria, Paediatrics and Child Health, Pretoria, Gauteng, South Africa
- University of Pretoria, Paediatrics and Child Health, Pretoria, Gauteng, South Africa
| | - Daniel J Weiner
- Children's Hospital of Pittsburgh, Perception of Pulmonary Function in Children with Asthma and Cystic Fibrosis, PITTSBURGH, Pennsylvania, United States
| | | | - Erik R Swenson
- University of Washington, 7284, Division of Pulmonary, Seattle, Washington, United States
- Veterans Affairs Puget Sound Healthcare System, Section of Pulmonary, Critical Care and Sleep Medicine, Seattle, Washington, United States
| | - Margaret Rosenfeld
- Seattle Children's, Pediatrics / Pulmonary, Seattle, Washington, United States
| | - Richard M Schwartzstein
- Beth Israel Deaconess Medical Center, 1859, Pulmonary, Critical Care, and Sleep Medicine, Boston, Massachusetts, United States
| | - Anurag Agrawal
- Institute of Genomics and Integrative Biology, Delhi, Delhi, India, Molecular Immunology and Immunogenetics, Delhi, India
| | - Enid Neptune
- Johns Hopkins, Medicine/Pulmonary and Critical Care, Baltimore, Maryland, United States
| | - Juan P Wisnivesky
- Icahn School of Medicine at Mount Sinai, Medicine, New York, New York, United States
| | - Victor E Ortega
- Mayo Clinic, 6915, Internal Medicine, Division of Respiratory Medicine, Scottsdale, Arizona, United States
| | - Peter Burney
- Imperial College, Respiratory Epidemiology and Public Health, London, United Kingdom of Great Britain and Northern Ireland
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Ha JW, Aguilera J, Jung YS, Cansdale S, Lurmann F, Lutzker L, Hammond K, Balmes J, Noth E, Eisen E, Aghaeepour N, Shaw G, Waldrop A, Khatri P, Utz P, Rosenburg-Hasson Y, Maecker H, Burt T, Nadeau K, Prunicki M. The impacts of ambient air pollution exposure during pregnancy on maternal and neonatal inflammatory biomarkers. J Allergy Clin Immunol 2023. [DOI: 10.1016/j.jaci.2022.12.377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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6
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Lu W, Wang LA, Mann J, Jenny A, Romero C, Kuster A, Canuz E, Pillarisetti A, Smith KR, Balmes J, Thompson L. Biomass Smoke Exposure and Atopy among Young Children in the Western Highlands of Guatemala: A Prospective Cohort Study. Int J Environ Res Public Health 2022; 19:14064. [PMID: 36360942 PMCID: PMC9656762 DOI: 10.3390/ijerph192114064] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 10/21/2022] [Accepted: 10/26/2022] [Indexed: 06/16/2023]
Abstract
Women and children in rural regions of low-income countries are exposed to high levels of household air pollution (HAP) as they traditionally tend to household chores such as cooking with biomass fuels. Early life exposure to air pollution is associated with aeroallergen sensitization and developing allergic diseases at older ages. This prospective cohort study assigned HAP-reducing chimney stoves to 557 households in rural Guatemala at different ages of the study children. The children's air pollution exposure was measured using personal CO diffusion tubes. Allergic outcomes at 4-5 years old were assessed using skin prick tests and International Study of Asthma and Allergies in Childhood (ISAAC)-based questionnaires. Children assigned to improved stoves before 6 months old had the lowest HAP exposure compared to the other groups. Longer exposure to the unimproved stoves was associated with higher risks of maternal-reported allergic asthma (OR = 2.42, 95% CI: 1.11-5.48) and rhinitis symptoms (OR = 2.01, 95% CI: 1.13-3.58). No significant association was found for sensitization to common allergens such as dust mites and cockroaches based on skin prick tests. Reducing HAP by improving biomass burning conditions might be beneficial in preventing allergic diseases among children in rural low-income populations.
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Affiliation(s)
- Wenxin Lu
- School of Public Health, University of California, Berkeley, CA 94720, USA
| | - Laura Ann Wang
- Department of Pediatrics, University of Colorado, Aurora, CO 80045, USA
| | - Jennifer Mann
- School of Public Health, University of California, Berkeley, CA 94720, USA
| | - Alisa Jenny
- Institute for Global Health Sciences, University of California, San Francisco, CA 94158, USA
| | - Carolina Romero
- Centro de Estudios en Salud, Universidad del Valle de Guatemala, Guatemala City 01015, Guatemala
| | - Andrea Kuster
- School of Nursing, University of California, San Francisco, CA 94158, USA
| | - Eduardo Canuz
- Centro de Estudios en Salud, Universidad del Valle de Guatemala, Guatemala City 01015, Guatemala
| | - Ajay Pillarisetti
- School of Public Health, University of California, Berkeley, CA 94720, USA
| | - Kirk R. Smith
- School of Public Health, University of California, Berkeley, CA 94720, USA
| | - John Balmes
- School of Public Health, University of California, Berkeley, CA 94720, USA
| | - Lisa Thompson
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA 30322, USA
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7
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Binegdie AB, Brenac S, Devereux G, Meme H, El Sony A, Gebremariam TH, Osman R, Miheso B, Mungai B, Zurba L, Lesosky M, Balmes J, Burney PJ, Mortimer K. Post-TB lung disease in three African countries. Int J Tuberc Lung Dis 2022; 26:891-893. [PMID: 35996284 PMCID: PMC9423016 DOI: 10.5588/ijtld.22.0261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- A B Binegdie
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - S Brenac
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - G Devereux
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - H Meme
- Centre for Respiratory Diseases Research, Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
| | - A El Sony
- Epidemiological Laboratory (Epi-Lab) for Public Health, Research and Development, Khartoum, Sudan
| | - T H Gebremariam
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - R Osman
- Epidemiological Laboratory (Epi-Lab) for Public Health, Research and Development, Khartoum, Sudan
| | - B Miheso
- Centre for Respiratory Diseases Research, Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
| | - B Mungai
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK, Centre for Health Solutions-Kenya, Nairobi, Kenya
| | - L Zurba
- Education for Health Africa, Durban, South Africa
| | - M Lesosky
- Division of Epidemiology Biostatistics, School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa
| | - J Balmes
- University of California, San Francisco, CA, USA
| | - P J Burney
- National Heart and Lung Institute, Imperial College London, London, UK
| | - K Mortimer
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK, University of Cambridge, Cambridge, UK
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Meza E, Giglio L, Franco AO, Rodriguez E, Stock L, Balmes J, Torres JM, Fernandez A. Worker Perspectives on COVID-19 Risks: A Qualitative Study of Latino Construction Workers in Oakland, California. Int J Environ Res Public Health 2022; 19:ijerph19169822. [PMID: 36011454 PMCID: PMC9408167 DOI: 10.3390/ijerph19169822] [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] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 07/30/2022] [Accepted: 08/05/2022] [Indexed: 05/10/2023]
Abstract
Latino construction workers in the U.S. have faced a disproportionate risk for COVID-19 infection in the workplace. Prior studies have focused on quantifying workplace risk for COVID-19 infection; few have captured workers' experiences and perspectives. This study describes COVID-19-related workplace risks from the perspectives of Latino construction workers. We conducted a qualitative study using semi-structured phone interviews with Latino construction workers from the Fruitvale District of Oakland, California. Twenty individuals were interviewed from December 2020 to March 2021. Nearly all participants (19/20) were Spanish-speaking men; mean age 42.6 years. The majority were low-income and over one-third did not have health insurance. Participants worked in varied construction-related jobs ranging from demolition to office work; additionally, four were day laborers, and three belonged to a labor union. We identified four major themes with public health policy and workplace safety implications: (1) Major concern about the risk of SARS-CoV-2 infection for family health and economic wellbeing; (2) Clarity about mask use and social distancing but not disclosure; (3) Variability in access to additional resources provided by employers; and (4) Uncertainty around structural support for SARS-CoV-2 quarantine/isolation. Our findings provide further evidence from workers' own perspectives of the major gaps experienced during the pandemic in workplace protections and resources.
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Affiliation(s)
- Erika Meza
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA 94158, USA
- Correspondence:
| | - Leslie Giglio
- Department of Medicine, Division of General Internal Medicine, Zuckerberg San Francisco General Hospital, University of California, San Francisco, CA 94110, USA
| | - Ana O. Franco
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA 94158, USA
| | - Elizabeth Rodriguez
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA 94158, USA
- Department of Biology, San Francisco State University, San Francisco, CA 94132, USA
| | - Laura Stock
- Labor Occupational Health Program, School of Public Health, University of California, Berkeley, CA 94720, USA
| | - John Balmes
- Division of Occupational and Environmental Medicine, School of Medicine, University of California, San Francisco, CA 94143, USA
- Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley, CA 94704, USA
| | - Jacqueline M. Torres
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA 94158, USA
| | - Alicia Fernandez
- Department of Medicine, Division of General Internal Medicine, Zuckerberg San Francisco General Hospital, University of California, San Francisco, CA 94110, USA
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9
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Aguilera J, Han X, Cao S, Balmes J, Lurmann F, Tyner T, Lutzker L, Noth E, Hammond SK, Sampath V, Burt T, Utz PJ, Khatri P, Aghaeepour N, Maecker H, Prunicki M, Nadeau K. Increases in ambient air pollutants during pregnancy are linked to increases in methylation of IL4, IL10, and IFNγ. Clin Epigenetics 2022; 14:40. [PMID: 35287715 PMCID: PMC8919561 DOI: 10.1186/s13148-022-01254-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 02/21/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Ambient air pollutant (AAP) exposure is associated with adverse pregnancy outcomes, such as preeclampsia, preterm labor, and low birth weight. Previous studies have shown methylation of immune genes associate with exposure to air pollutants in pregnant women, but the cell-mediated response in the context of typical pregnancy cell alterations has not been investigated. Pregnancy causes attenuation in cell-mediated immunity with alterations in the Th1/Th2/Th17/Treg environment, contributing to maternal susceptibility. We recruited women (n = 186) who were 20 weeks pregnant from Fresno, CA, an area with chronically elevated AAP levels. Associations of average pollution concentration estimates for 1 week, 1 month, 3 months, and 6 months prior to blood draw were associated with Th cell subset (Th1, Th2, Th17, and Treg) percentages and methylation of CpG sites (IL4, IL10, IFNγ, and FoxP3). Linear regression models were adjusted for weight, age, season, race, and asthma, using a Q value as the false-discovery-rate-adjusted p-value across all genes. RESULTS Short-term and mid-term AAP exposures to fine particulate matter (PM2.5), nitrogen dioxide (NO2) carbon monoxide (CO), and polycyclic aromatic hydrocarbons (PAH456) were associated with percentages of immune cells. A decrease in Th1 cell percentage was negatively associated with PM2.5 (1 mo/3 mo: Q < 0.05), NO2 (1 mo/3 mo/6 mo: Q < 0.05), and PAH456 (1 week/1 mo/3 mo: Q < 0.05). Th2 cell percentages were negatively associated with PM2.5 (1 week/1 mo/3 mo/6 mo: Q < 0.06), and NO2 (1 week/1 mo/3 mo/6 mo: Q < 0.06). Th17 cell percentage was negatively associated with NO2 (3 mo/6 mo: Q < 0.01), CO (1 week/1 mo: Q < 0.1), PM2.5 (3 mo/6 mo: Q < 0.05), and PAH456 (1 mo/3 mo/6 mo: Q < 0.08). Methylation of the IL10 gene was positively associated with CO (1 week/1 mo/3 mo: Q < 0.01), NO2 (1 mo/3 mo/6 mo: Q < 0.08), PAH456 (1 week/1 mo/3 mo: Q < 0.01), and PM2.5 (3 mo: Q = 0.06) while IL4 gene methylation was positively associated with concentrations of CO (1 week/1 mo/3 mo/6 mo: Q < 0.09). Also, IFNγ gene methylation was positively associated with CO (1 week/1 mo/3 mo: Q < 0.05) and PAH456 (1 week/1 mo/3 mo: Q < 0.06). CONCLUSION Exposure to several AAPs was negatively associated with T-helper subsets involved in pro-inflammatory and anti-inflammatory responses during pregnancy. Methylation of IL4, IL10, and IFNγ genes with pollution exposure confirms previous research. These results offer insights into the detrimental effects of air pollution during pregnancy, the demand for more epigenetic studies, and mitigation strategies to decrease pollution exposure during pregnancy.
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Affiliation(s)
- Juan Aguilera
- Sean N. Parker Center for Allergy and Asthma Research, Stanford University, 240 Pasteur, Stanford, CA, 94305, USA
| | - Xiaorui Han
- Sean N. Parker Center for Allergy and Asthma Research, Stanford University, 240 Pasteur, Stanford, CA, 94305, USA
| | - Shu Cao
- Sean N. Parker Center for Allergy and Asthma Research, Stanford University, 240 Pasteur, Stanford, CA, 94305, USA
| | - John Balmes
- Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley, CA, USA
- Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | | | - Tim Tyner
- University of California, San Francisco-Fresno, Fresno, CA, USA
- Central California Asthma Collaborative, Fresno, USA
| | - Liza Lutzker
- Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley, CA, USA
| | - Elizabeth Noth
- Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley, CA, USA
| | - S Katharine Hammond
- Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley, CA, USA
| | - Vanitha Sampath
- Sean N. Parker Center for Allergy and Asthma Research, Stanford University, 240 Pasteur, Stanford, CA, 94305, USA
| | - Trevor Burt
- Department of Pediatrics, Division of Neonatology and the Translating Duke Health Children's Health and Discovery Initiative, Duke University School of Medicine, 701 W Main St., Chesterfield Building, Suite 510, Durham, NC, 27701, USA
| | - P J Utz
- Department of Medicine, Division of Immunology and Rheumatology, Stanford University School of Medicine, Stanford University, 291 Campus Drive, Stanford, CA, 94305, USA
| | - Purvesh Khatri
- Center for Biomedical Informatics, Department of Medicine, Stanford University School of Medicine, Stanford University, 291 Campus Drive, Stanford, CA, 94305, USA
| | - Nima Aghaeepour
- Departments of Biomedical Data Sciences, Stanford University, 291 Campus Drive, Stanford, CA, 94305, USA
| | - Holden Maecker
- Institute for Immunity, Transplantation and Infection, Stanford University, 291 Campus Drive, Stanford, CA, 94305, USA
| | - Mary Prunicki
- Sean N. Parker Center for Allergy and Asthma Research, Stanford University, 240 Pasteur, Stanford, CA, 94305, USA
| | - Kari Nadeau
- Sean N. Parker Center for Allergy and Asthma Research, Stanford University, 240 Pasteur, Stanford, CA, 94305, USA.
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10
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Walker ES, Fedak KM, Good N, Balmes J, Brook RD, Clark ML, Cole-Hunter T, Devlin RB, L’Orange C, Luckasen G, Mehaffy J, Shelton R, Wilson A, Volckens J, Peel JL. Acute differences in blood lipids and inflammatory biomarkers following controlled exposures to cookstove air pollution in the STOVES study. Int J Environ Health Res 2022; 32:565-578. [PMID: 32615777 PMCID: PMC7775880 DOI: 10.1080/09603123.2020.1785402] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [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: 03/31/2020] [Revised: 06/15/2020] [Accepted: 06/17/2020] [Indexed: 05/24/2023]
Abstract
Household air pollution is a leading risk factor for morbidity and premature mortality. Numerous cookstoves have been developed to reduce household air pollution, but it is unclear whether such cookstoves meaningfully improve health. In a controlled exposure study with a crossover design, we assessed the effect of pollution emitted from multiple cookstoves on acute differences in blood lipids and inflammatory biomarkers. Participants (n = 48) were assigned to treatment sequences of exposure to air pollution emitted from five cookstoves and a filtered-air control. Blood lipids and inflammatory biomarkers were measured before and 0, 3, and 24 hours after treatments. Many of the measured outcomes had inconsistent results. However, compared to control, intercellular adhesion molecule-1 was higher 3 hours after all treatments, and C-reactive protein and serum amyloid-A were higher 24 hours after the highest treatment. Our results suggest that short-term exposure to cookstove air pollution can increase inflammatory biomarkers within 24 hours.
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Affiliation(s)
- Ethan S. Walker
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, CO, USA
| | - Kristen M. Fedak
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, CO, USA
| | - Nicholas Good
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, CO, USA
| | - John Balmes
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Robert D. Brook
- Division of Cardiovascular Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Maggie L. Clark
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, CO, USA
| | - Tom Cole-Hunter
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, CO, USA
| | - Robert B. Devlin
- Environmental Public Health Division, United States Environmental Protection Agency, Research Triangle Park, NC, USA
| | - Christian L’Orange
- Department of Mechanical Engineering, Colorado State University, Fort Collins, CO, USA
| | | | - John Mehaffy
- Department of Mechanical Engineering, Colorado State University, Fort Collins, CO, USA
| | - Rhiannon Shelton
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, CO, USA
| | - Ander Wilson
- Department of Statistics, Colorado State University, Fort Collins, CO, USA
| | - John Volckens
- Department of Mechanical Engineering, Colorado State University, Fort Collins, CO, USA
| | - Jennifer L. Peel
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, CO, USA
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11
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Binegdie AB, Meme H, El Sony A, Haile T, Osman R, Miheso B, Zurba L, Lesosky M, Balmes J, Burney PJ, Mortimer K, Devereux G. Chronic respiratory disease in adult outpatients in three African countries: a cross-sectional study. Int J Tuberc Lung Dis 2022; 26:18-25. [PMID: 34969424 PMCID: PMC8734192 DOI: 10.5588/ijtld.21.0362] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND: The greatest burden of chronic respiratory disease is in low- and middle-income countries, with recent population-based studies reporting substantial levels of obstructive and restrictive lung function.OBJECTIVE: To characterise the common chronic respiratory diseases encountered in hospital outpatient clinics in three African countries.METHODS This was a cross-sectional study of consecutive adult patients with chronic respiratory symptoms (>8 weeks) attending hospital outpatient departments in Ethiopia, Kenya and Sudan. Patients were assessed using a respiratory questionnaire, spirometry and chest radiography. The diagnoses of the reviewing clinicians were ascertained.RESULT: A total of 519 patients (209 Kenya, 170 Ethiopia, 140 Sudan) participated; the mean age was 45.2 years (SD 16.2); 53% were women, 83% had never smoked. Reviewing clinicians considered that 36% (95% CI 32-40) of patients had asthma, 25% (95% CI 21-29) had chronic bronchitis, 8% (95% CI 6-11) chronic obstructive pulmonary disease (COPD), 5% (95% CI 4-8) bronchiectasis and 4% (95% CI 3-6) post-TB lung disease. Spirometry consistent with COPD was present in 35% (95% CI 30-39). Restriction was evident in 38% (95% CI 33-43). There was evidence of sub-optimal diagnosis of asthma and COPD.CONCLUSION: In Ethiopia, Kenya and Sudan, asthma, COPD and chronic bronchitis account for the majority of diagnoses in non-TB patients with chronic respiratory symptoms. The suboptimal diagnosis of these conditions will require the widespread use of spirometry.
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Affiliation(s)
- A B Binegdie
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - H Meme
- Centre for Respiratory Diseases Research, Kenyan Medical Research Institute (KEMRI), Nairobi, Kenya
| | - A El Sony
- Epidemiological Laboratory (Epi-Lab) for Public Health, Research and Development, Khartoum, Sudan
| | - T Haile
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - R Osman
- Epidemiological Laboratory (Epi-Lab) for Public Health, Research and Development, Khartoum, Sudan
| | - B Miheso
- Centre for Respiratory Diseases Research, Kenyan Medical Research Institute (KEMRI), Nairobi, Kenya
| | - L Zurba
- Education for Health Africa, Durban, South Africa
| | - M Lesosky
- Division of Epidemiology Biostatistics, School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa
| | - J Balmes
- University of California, San Francisco, CA, USA
| | - P J Burney
- National Heart and Lung Institute, Imperial College London, London, UK
| | - K Mortimer
- Liverpool School of Tropical Medicine, Liverpool, UK
| | - G Devereux
- Liverpool School of Tropical Medicine, Liverpool, UK
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12
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Abstract
Pollution from landscape fires, which are increasing with climate change, leads to babies being born with lower birthweights in low- and middle-income countries.
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Affiliation(s)
- Stephanie M Holm
- Department of Medicine, University of California, San Francisco, San Francisco, United States
| | - John Balmes
- Department of Medicine, University of California, San Francisco, San Francisco, United States
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13
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Njoroge MW, Mjojo P, Chirwa C, Rylance S, Nightingale R, Gordon SB, Mortimer K, Burney P, Balmes J, Rylance J, Obasi A, Niessen LW, Devereux G. Changing lung function and associated health-related quality-of-life: A five-year cohort study of Malawian adults. EClinicalMedicine 2021; 41:101166. [PMID: 34712931 PMCID: PMC8529201 DOI: 10.1016/j.eclinm.2021.101166] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 10/04/2021] [Accepted: 10/04/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND In Sub-Saharan Africa cross-sectional studies report a high prevalence of abnormal lung function indicative of chronic respiratory disease. The natural history and health impact of this abnormal lung function in low-and middle-income countries is largely unknown. METHODS A cohort of 1481 adults representative of rural Chikwawa in Malawi were recruited in 2014 and followed-up in 2019. Respiratory symptoms and health-related quality of life (HRQoL) were quantified. Lung function was measured by spirometry. FINDINGS 1232 (83%) adults participated; spirometry was available for 1082 (73%). Mean (SD) age 49.5 (17.0) years, 278(23%) had ever smoked, and 724 (59%) were women. Forced expiratory volume in one second (FEV1) declined by 53.4 ml/year (95% CI: 49.0, 57.8) and forced vital capacity (FVC) by 45.2 ml/year (95% CI: 39.2, 50.5) . Chronic airflow obstruction increased from 9.5% (7.6, 11.6%) in 2014 to 17.5% (15.3, 19.9%) in 2019. There was no change in diagnosed asthma or in spirometry consistent with asthma or restriction. Rate of FEV1 decline was not associated with diagnosed Chronic obstructive pulmonary disease (COPD), asthma, or spirometry consistent with asthma, COPD, or restriction. HRQoL was adversely associated with respiratory symptoms (dyspnoea, wheeze, cough), previous tuberculosis, declining FEV1 and spirometry consistent with asthma or restriction. These differences exceeded the minimally important difference. INTERPRETATION In this cohort, the increasing prevalence of COPD is associated with the high rate of FEV1 decline and lung function deficits present before recruitment. Respiratory symptoms and sub-optimal lung function are independently associated with reduced HRQoL.
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Affiliation(s)
- Martin W. Njoroge
- Department of Clinical Sciences and International Public Health, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L3 5QA, UK
- Malawi Liverpool Wellcome Trust Programme, Blantyre, Malawi
- Corresponding author at: Department of Clinical Sciences and International Public Health, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L3 5QA, UK.
| | - Patrick Mjojo
- Malawi Liverpool Wellcome Trust Programme, Blantyre, Malawi
| | | | - Sarah Rylance
- Department of Clinical Sciences and International Public Health, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L3 5QA, UK
- Malawi Liverpool Wellcome Trust Programme, Blantyre, Malawi
| | - Rebecca Nightingale
- Department of Clinical Sciences and International Public Health, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L3 5QA, UK
| | - Stephen B. Gordon
- Department of Clinical Sciences and International Public Health, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L3 5QA, UK
- Malawi Liverpool Wellcome Trust Programme, Blantyre, Malawi
| | - Kevin Mortimer
- Department of Clinical Sciences and International Public Health, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L3 5QA, UK
- Liverpool University Hospital NHS Foundation Trust, Liverpool, UK
| | - Peter Burney
- National Heart and Lung Institute, Imperial College, London, UK
| | - John Balmes
- University of California, San Francisco, United States of America
- University of California, Berkeley, United States of America
| | - Jamie Rylance
- Department of Clinical Sciences and International Public Health, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L3 5QA, UK
- Malawi Liverpool Wellcome Trust Programme, Blantyre, Malawi
| | - Angela Obasi
- Department of Clinical Sciences and International Public Health, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L3 5QA, UK
| | - Louis W. Niessen
- Department of Clinical Sciences and International Public Health, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L3 5QA, UK
- John Hopkins Bloomberg School of Public Health, Baltimore, United States of America
| | - Graham Devereux
- Department of Clinical Sciences and International Public Health, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L3 5QA, UK
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14
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Su JG, Barrett MA, Combs V, Henderson K, Van Sickle D, Hogg C, Simrall G, Moyer SS, Tarini P, Wojcik O, Sublett J, Smith T, Renda AM, Balmes J, Gondalia R, Kaye L, Jerrett M. Identifying impacts of air pollution on subacute asthma symptoms using digital medication sensors. Int J Epidemiol 2021; 51:213-224. [PMID: 34664072 DOI: 10.1093/ije/dyab187] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Objective tracking of asthma medication use and exposure in real-time and space has not been feasible previously. Exposure assessments have typically been tied to residential locations, which ignore exposure within patterns of daily activities. METHODS We investigated the associations of exposure to multiple air pollutants, derived from nearest air quality monitors, with space-time asthma rescue inhaler use captured by digital sensors, in Jefferson County, Kentucky. A generalized linear mixed model, capable of accounting for repeated measures, over-dispersion and excessive zeros, was used in our analysis. A secondary analysis was done through the random forest machine learning technique. RESULTS The 1039 participants enrolled were 63.4% female, 77.3% adult (>18) and 46.8% White. Digital sensors monitored the time and location of over 286 980 asthma rescue medication uses and associated air pollution exposures over 193 697 patient-days, creating a rich spatiotemporal dataset of over 10 905 240 data elements. In the generalized linear mixed model, an interquartile range (IQR) increase in pollutant exposure was associated with a mean rescue medication use increase per person per day of 0.201 [95% confidence interval (CI): 0.189-0.214], 0.153 (95% CI: 0.136-0.171), 0.131 (95% CI: 0.115-0.147) and 0.113 (95% CI: 0.097-0.129), for sulphur dioxide (SO2), nitrogen dioxide (NO2), fine particulate matter (PM2.5) and ozone (O3), respectively. Similar effect sizes were identified with the random forest model. Time-lagged exposure effects of 0-3 days were observed. CONCLUSIONS Daily exposure to multiple pollutants was associated with increases in daily asthma rescue medication use for same day and lagged exposures up to 3 days. Associations were consistent when evaluated with the random forest modelling approach.
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Affiliation(s)
- Jason G Su
- Division of Environmental Health Sciences, School of Public Health, University of California at Berkeley, Berkeley, CA, USA
| | | | - Veronica Combs
- Center for Healthy Air, Water and Soil, University of Louisville, Louisville, KY, USA
| | | | - David Van Sickle
- Propeller Health, Madison, WI, USA.,Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
| | - Chris Hogg
- Propeller Health, San Francisco, CA, USA
| | - Grace Simrall
- Louisville Metro, Office of Civic Innovation, Louisville, KY, USA
| | - Sarah S Moyer
- Louisville Metro, Department of Public Health and Wellness, Louisville, KY, USA
| | - Paul Tarini
- Robert Wood Johnson Foundation, Princeton, NJ, USA
| | | | | | - Ted Smith
- Center for Healthy Air, Water and Soil, University of Louisville, Louisville, KY, USA.,Envirome Institute, School of Medicine, University of Louisville, Louisville, KY, USA
| | | | - John Balmes
- Division of Environmental Health Sciences, School of Public Health, University of California at Berkeley, Berkeley, CA, USA
| | | | | | - Michael Jerrett
- Fielding School of Public Health, University of California, Los Angeles, CA, USA
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15
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Rice M, Balmes J, Malhotra A. Outdoor Air Pollution and Your Health. Am J Respir Crit Care Med 2021; 204:P13-P14. [PMID: 34609258 DOI: 10.1164/rccm.2046p13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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16
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Blount RJ, Phan H, Trinh T, Dang H, Merrifield C, Zavala M, Zabner J, Comellas AP, Stapleton EM, Segal MR, Balmes J, Nhung NV, Nahid P. Indoor Air Pollution and Susceptibility to Tuberculosis Infection in Urban Vietnamese Children. Am J Respir Crit Care Med 2021; 204:1211-1221. [PMID: 34343025 DOI: 10.1164/rccm.202101-0136oc] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
RATIONALE The Southeast Asian tuberculosis burden is high, and it remains unclear if urban indoor air pollution in this setting is exacerbating the epidemic. OBJECTIVES To determine the associations of latent tuberculosis with common urban indoor air pollution sources (secondhand smoke, indoor motorcycle emissions, and cooking) in Southeast Asia. METHODS We enrolled child household contacts of patients with microbiologically confirmed active tuberculosis in Vietnam, July 2017-December 2019. We tested children for latent tuberculosis and evaluated air pollution exposures with questionnaires and personal aerosol sampling. We tested hypotheses using generalized estimating equations. MEASUREMENTS AND MAIN RESULTS We enrolled 72 tuberculosis patients (27% with cavitary disease) and 109 of their child household contacts. Of household contacts, 58 (53%) were diagnosed with latent tuberculosis at baseline visit. Children experienced a 2.56-fold increased odds of latent tuberculosis for each additional household member who smoked (95%CI 1.27-5.16). Odds were highest among children exposed to indoor smokers and children under five years old exposed to household smokers. Each residential floor above street-level pollution decreased the odds of latent tuberculosis by 36% (aOR 0.64, 95%CI 0.42-0.96). Motorcycles parked inside children's homes and cooking with liquid petroleum gas compared to electricity increased the odds of latent tuberculosis while kitchen ventilation decreased the effect, but these findings were not statistically significant. CONCLUSION Common urban indoor air pollution sources were associated with increased odds of latent tuberculosis infection in child household contacts of active tuberculosis patients.
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Affiliation(s)
- Robert J Blount
- UI Carver College of Medicine, 12243, Pulmonary and Critical Care Medicine, Iowa City, Iowa, United States;
| | - Ha Phan
- Vietnam National Tuberculosis Program - University of California San Francisco Research Collaboration Unit, Hanoi, Viet Nam.,Center for Promotion of Advancement of Society, Vietnam, Hanoi, Viet Nam
| | - Trang Trinh
- Vietnam National Tuberculosis Program - University of California San Francisco Research Collaboration Unit, Hanoi, Viet Nam.,Center for Promotion of Advancement of Society, Vietnam, Hanoi, Viet Nam
| | - Hai Dang
- Vietnam National Tuberculosis Program - University of California San Francisco Research Collaboration Unit, Hanoi, Viet Nam.,Center for Promotion of Advancement of Society, Vietnam, Hanoi, Viet Nam
| | - Cindy Merrifield
- University of California San Francisco, 8785, Pulmonary and Critical Care Medicine, San Francisco, California, United States.,University of California San Francisco, 8785, Center for Tuberculosis, San Francisco, California, United States.,Vietnam National Tuberculosis Program - University of California San Francisco Research Collaboration Unit, San Francisco, California, United States
| | - Michael Zavala
- UI Carver College of Medicine, 12243, Pulmonary and Critical Care Medicine, Iowa City, Iowa, United States
| | - Joseph Zabner
- UI Carver College of Medicine, 12243, Pulmonary and Critical Care Medicine, Iowa City, Iowa, United States
| | - Alejandro P Comellas
- University of Iowa, 4083, Pulmonary and Critical Care Medicine, Iowa City, Iowa, United States
| | - Emma M Stapleton
- UI Carver College of Medicine, 12243, Iowa City, Iowa, United States
| | - Mark R Segal
- University of California San Francisco, 8785, Department of Epidemiology and Biostatistics, San Francisco, California, United States
| | - John Balmes
- University of California, Berkeley, Environmental Health Sciences, School of Public Health, Berkeley, California, United States.,University of California, San Francisco, Department of Medicine, San Francisco, California, United States
| | - Nguyen Viet Nhung
- Vietnam National Tuberculosis Program - University of California San Francisco Research Collaboration Unit, Hanoi, Viet Nam.,Vietnam National Tuberculosis Program, Hanoi, Viet Nam
| | - Payam Nahid
- University of California San Francisco, 8785, Pulmonary and Critical Care Medicine, San Francisco, California, United States.,University of California San Francisco, 8785, Center for Turberculosis, San Francisco, California, United States.,Vietnam National Tuberculosis Program - University of California San Francisco Research Collaboration Unit, San Francisco, United States
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17
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Chen YH, Glymour M, Riley A, Balmes J, Duchowny K, Harrison R, Matthay E, Bibbins-Domingo K. Excess mortality associated with the COVID-19 pandemic among Californians 18-65 years of age, by occupational sector and occupation: March through November 2020. PLoS One 2021; 16:e0252454. [PMID: 34086762 PMCID: PMC8177528 DOI: 10.1371/journal.pone.0252454] [Citation(s) in RCA: 131] [Impact Index Per Article: 43.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 05/14/2021] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Though SARS-CoV-2 outbreaks have been documented in occupational settings and in-person essential work has been suspected as a risk factor for COVID-19, occupational differences in excess mortality have, to date, not been examined. Such information could point to opportunities for intervention, such as vaccine prioritization or regulations to enforce safer work environments. METHODS AND FINDINGS Using autoregressive integrated moving average models and California Department of Public Health data representing 356,188 decedents 18-65 years of age who died between January 1, 2016 and November 30, 2020, we estimated pandemic-related excess mortality by occupational sector and occupation, with additional stratification of the sector analysis by race/ethnicity. During these first 9 months of the COVID-19 pandemic, working-age adults experienced 11,628 more deaths than expected, corresponding to 22% relative excess and 46 excess deaths per 100,000 living individuals. Sectors with the highest relative and per-capita excess mortality were food/agriculture (39% relative excess; 75 excess deaths per 100,000), transportation/logistics (31%; 91 per 100,000), manufacturing (24%; 61 per 100,000), and facilities (23%; 83 per 100,000). Across racial and ethnic groups, Latino working-age Californians experienced the highest relative excess mortality (37%) with the highest excess mortality among Latino workers in food and agriculture (59%; 97 per 100,000). Black working-age Californians had the highest per-capita excess mortality (110 per 100,000), with relative excess mortality highest among transportation/logistics workers (36%). Asian working-age Californians had lower excess mortality overall, but notable relative excess mortality among health/emergency workers (37%), while White Californians had high per-capita excess deaths among facilities workers (70 per 100,000). CONCLUSIONS Certain occupational sectors are associated with high excess mortality during the pandemic, particularly among racial and ethnic groups also disproportionately affected by COVID-19. In-person essential work is a likely venue of transmission of coronavirus infection and must be addressed through vaccination and strict enforcement of health orders in workplace settings.
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Affiliation(s)
- Yea-Hung Chen
- Institute for Global Health Sciences, University of California, San Francisco, California, United States of America
| | - Maria Glymour
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California, United States of America
| | - Alicia Riley
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California, United States of America
| | - John Balmes
- Department of Medicine, University of California, San Francisco, California, United States of America
| | - Kate Duchowny
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California, United States of America
| | - Robert Harrison
- Department of Medicine, University of California, San Francisco, California, United States of America
| | - Ellicott Matthay
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California, United States of America
| | - Kirsten Bibbins-Domingo
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California, United States of America
- Department of Medicine, University of California, San Francisco, California, United States of America
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18
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Saleh S, Shepherd W, Jewell C, Lam NL, Balmes J, Bates MN, Lai PS, Ochieng CA, Chinouya M, Mortimer K. Air pollution interventions and respiratory health: a systematic review. Int J Tuberc Lung Dis 2021; 24:150-164. [PMID: 32127098 DOI: 10.5588/ijtld.19.0417] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND: Indoor and ambient air pollution exposure is a major risk to respiratory health worldwide, particularly in low- and middle-income countries (LMICs). Interventional trials have mainly focused on alternatives to cooking stoves, with mixed results. Beyond cooking, additional sources of particulate matter also contribute to the burden of air pollution exposure. This review explores evidence from current randomised controlled trials (RCTs) on the clinical effectiveness of interventions to reduce particulate matter in LMICs.METHODS: Twelve databases and the grey literature (e.g., Government reports and policy papers) were searched. Eligible studies were RCTs conducted in LMICs aiming to reduce particulate exposure from any source and reporting on at least one clinical respiratory outcome (respiratory symptoms, lung function or clinical diagnoses). Data from relevant studies were systematically extracted, the risk of bias assessed and narrative synthesis provided.RESULTS: Of the 14 included studies, 12 tested 'improved' cookstoves, most using biomass, but solar and bioethanol cookers were also included. One trial used solar lamps and another was an integrated intervention incorporating behavioural and environmental components for the treatment and prevention of chronic obstructive pulmonary disease. Of the six studies reporting child pneumonia outcomes, none demonstrated significant benefit in intention-to-treat analysis. Ten studies reported respiratory symptom outcomes with some improvements seen, but self-reporting made these outcomes highly vulnerable to bias. Substantial inter-study clinical and methodological heterogeneity precluded calculation of pooled effect estimates.CONCLUSION: Evidence from the RCTs performed to date suggests that individual household-level interventions for air pollution exposure reduction have limited benefits for respiratory health. More comprehensive approaches to air pollution exposure reduction must be developed so their potential health benefits can be assessed.
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Affiliation(s)
- S Saleh
- Liverpool School of Tropical Medicine, London, UK, Malawi-Liverpool-Wellcome Trust Programme, Lilongwe, Malawi
| | - W Shepherd
- Liverpool School of Tropical Medicine, London, UK
| | - C Jewell
- Lancaster University, Lancaster, UK
| | - N L Lam
- Schatz Energy Research Center, Humboldt State University, Arcata, CA
| | - J Balmes
- University of California, San Francisco, San Francisco, CA, University of California, Berkeley, CA
| | - M N Bates
- University of California, Berkeley, CA
| | - P S Lai
- Harvard Medical School, Boston, MA, USA
| | - C A Ochieng
- National University of Ireland Galway, Galway, Ireland, Stockholm Environment Institute, Stockholm, Sweden
| | - M Chinouya
- Liverpool School of Tropical Medicine, London, UK
| | - K Mortimer
- Liverpool School of Tropical Medicine, London, UK
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19
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Affiliation(s)
- Megan Schwarzman
- School of Public Health, University of California, Berkeley, CA, USA.
| | | | | | | | - John Balmes
- School of Public Health, University of California, Berkeley, CA, USA.,Department of Medicine, University of California, San Francisco, CA, USA
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20
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Annesi-Maesano I, Forastiere F, Balmes J, Garcia E, Harkema J, Holgate S, Kelly F, Khreis H, Hoffmann B, Maesano CN, McConnell R, Peden D, Pinkerton K, Schikowski T, Thurston G, Van Winkle LS, Carlsten C. The clear and persistent impact of air pollution on chronic respiratory diseases: a call for interventions. Eur Respir J 2021; 57:57/3/2002981. [PMID: 33737377 DOI: 10.1183/13993003.02981-2020] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 11/09/2020] [Indexed: 12/13/2022]
Affiliation(s)
- Isabella Annesi-Maesano
- Sorbonne Université and INSERM, Epidemiology of Allergic and Respiratory Diseases Dept, Institut Pierre Louis of Epidemiology and Public Health, Paris, France
| | | | - John Balmes
- University of California Berkeley-University of California San Francisco Joint Medical Program, Berkeley, CA, USA.,School of Public Health, University of California, Berkeley, CA, USA.,Dept of Medicine, School of Medicine, University of California, San Francisco, CA, USA
| | - Erika Garcia
- Dept of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Jack Harkema
- Dept of Pathobiology and Diagnostic Investigation, College of Veterinary Medicine, Michigan State University, East Lansing, MI, USA
| | - Stephen Holgate
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Frank Kelly
- Environmental Research Group, King's College, London, UK
| | - Haneen Khreis
- Center for Advancing Research in Transportation Emissions, Energy, and Health (CARTEEH), Texas A&M Transportation Institute (TTI), College Station, TX, USA
| | - Barbara Hoffmann
- Institute for Occupational, Social and Environmental Medicine, Center for Health and Society, Heinrich Heine University of Düsseldorf, Düsseldorf, Germany
| | - Cara Nichole Maesano
- Sorbonne Université and INSERM, Epidemiology of Allergic and Respiratory Diseases Dept, Institut Pierre Louis of Epidemiology and Public Health, Paris, France
| | - Rob McConnell
- University of Southern California, Preventive Medicine, Los Angeles, CA, USA
| | - David Peden
- Center for Environmental Medicine, Asthma and Lung Biology and Division of Allergy, Immunology and Rheumatology, Dept of Pediatrics, the School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Kent Pinkerton
- Center for Health and the Environment, John Muir Institute of the Environment, University of California, Davis, CA, USA
| | - Tamara Schikowski
- IUF-Leibniz Research Institute for Environmental Medicine, Düsseldorf, Germany
| | - George Thurston
- New York University School of Medicine, Dept of Environmental Medicine, New York, NY, USA
| | - Laura S Van Winkle
- Dept of Anatomy, Physiology and Cell Biology, School of Veterinary Medicine, University of California, Davis, Davis, CA, USA
| | - Christopher Carlsten
- Air Pollution Exposure Laboratory, Dept of Medicine, Division of Respiratory Medicine, The University of British Columbia, Vancouver, BC, Canada
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Dobson R, Siddiqi K, Ferdous T, Huque R, Lesosky M, Balmes J, Semple S. Diurnal variability of fine-particulate pollution concentrations: data from 14 low- and middle-income countries. Int J Tuberc Lung Dis 2021; 25:206-214. [PMID: 33688809 PMCID: PMC7948758 DOI: 10.5588/ijtld.20.0704] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND: Scientific understanding of indoor air pollution is predominately based on research carried out in cities in high-income countries (HICs). Less is known about how pollutant concentrations change over the course of a typical day in cities in low- and middle-income countries (LMICs).OBJECTIVE: To understand how concentrations of fine particulate matter smaller than 2.5 microns in diameter (PM2.5) change over the course of the day outdoors (across a range of countries) and indoors (using measurements from Dhaka, Bangladesh).DESIGN: Data on PM2.5 concentrations were gathered from 779 households in Dhaka as part of the MCLASS II (Muslim Communities Learning About Second-hand Smoke in Bangladesh) project, and compared to outdoor PM2.5 concentrations to determine the temporal variation in exposure to air pollution. Hourly PM2.5 data from 23 cities in 14 LMICs, as well as London (UK), Paris (France) and New York (NY, USA), were extracted from publicly available sources for comparison.RESULTS: PM2.5 in homes in Dhaka demonstrated a similar temporal pattern to outdoor measurements, with greater concentrations at night than in the afternoon. This pattern was also evident in 19 of 23 LMIC cities.CONCLUSION: PM2.5 concentrations are greater at night than during the afternoon in homes in Dhaka. Diurnal variations in PM2.5 in LMICs is substantial and greater than in London, Paris or New York. This has implications for public health community approaches to health effects of air pollution in LMICs.
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Affiliation(s)
- R. Dobson
- Institute for Social Marketing and Health, University of Stirling, Stirling, Scotland
| | - K. Siddiqi
- Department of Health Sciences, University of York, York, UK
| | - T. Ferdous
- Advancement through Research and Knowledge Foundation Bangladesh, Dhaka, Bangladesh
| | - R. Huque
- Advancement through Research and Knowledge Foundation Bangladesh, Dhaka, Bangladesh
| | - M. Lesosky
- Division of Epidemiology & Biostatistics, School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa
| | - J. Balmes
- Department of Medicine, University of California, San Francisco, CA
,School of Public Health, University of California, Berkeley, CA, USA
| | - S. Semple
- Institute for Social Marketing and Health, University of Stirling, Stirling, Scotland
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22
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Cole-Hunter T, Dhingra R, Fedak KM, Good N, L'Orange C, Luckasen G, Mehaffy J, Walker E, Wilson A, Balmes J, Brook RD, Clark ML, Devlin RB, Volckens J, Peel JL. Short-term differences in cardiac function following controlled exposure to cookstove air pollution: The subclinical tests on volunteers exposed to smoke (STOVES) study. Environ Int 2021; 146:106254. [PMID: 33221594 PMCID: PMC7775898 DOI: 10.1016/j.envint.2020.106254] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 06/18/2020] [Revised: 10/09/2020] [Accepted: 10/27/2020] [Indexed: 05/24/2023]
Abstract
BACKGROUND Exposure to household air pollution from solid fuel combustion for cooking and heating is an important risk factor for premature death and disability worldwide. Current evidence supports an association of ambient air pollution with cardiovascular disease but is limited for household air pollution and for cardiac function. Controlled exposure studies can complement evidence provided by field studies. OBJECTIVES To investigate effects of short-term, controlled exposures to emissions from five cookstoves on measures of cardiac function. METHODS Forty-eight healthy adults (46% female; 20-36 years) participated in six, 2-h exposures ('treatments'), including emissions from five cookstoves and a filtered-air control. Target fine particulate matter (PM2.5) exposure-concentrations per treatment were: control, 0 µg/m3; liquefied petroleum gas, 10 µg/m3; gasifier, 35 µg/m3; fan rocket, 100 µg/m3; rocket elbow, 250 µg/m3; and three stone fire, 500 µg/m3. Participants were treated in a set (pre-randomized) sequence as groups of 4 to minimize order bias and time-varying confounders. Heart rate variability (HRV) and cardiac repolarization metrics were calculated as 5-min means immediately and at 3 h following treatment, for analysis in linear mixed-effects models comparing cookstove to control. RESULTS Short-term differences in SDNN (standard deviation of duration of all NN intervals) and VLF (very-low frequency power) existed for several cookstoves compared to control. While all cookstoves compared to control followed a similar trend for SDNN, the greatest effect was seen immediately following three stone fire (β = -0.13 ms {%}; 95% confidence interval = -0.22, -0.03%), which reversed in direction at 3 h (0.03%; -0.06, 0.13%). VLF results were similar in direction and timing to SDNN; however, other HRV or cardiac repolarization results were not similar to those for SDNN. DISCUSSION We observed some evidence of short-term, effects on HRV immediately following cookstove treatments compared to control. Our results suggest that cookstoves with lower PM2.5 emissions are potentially capable of affecting cardiac function, similar to stoves emitting higher PM2.5 emissions.
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Affiliation(s)
- Tom Cole-Hunter
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, CO, USA; Centre for Air Pollution, Energy, and Health Research, University of New South Wales, Sydney, NSW, Australia; International Laboratory for Air Quality and Health, Institute of Health and Biomedical Innovation, Queensland University of Technology (QUT), Brisbane, QLD, Australia; Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Radhika Dhingra
- Department of Environmental Sciences and Engineering, University of North Carolina, NC, USA; Environmental Public Health Division, United States Environmental Protection Agency, Chapel Hill, NC, USA
| | - Kristen M Fedak
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, CO, USA
| | - Nicholas Good
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, CO, USA
| | - Christian L'Orange
- Department of Mechanical Engineering, Colorado State University, Fort Collins, CO, USA
| | | | - John Mehaffy
- Department of Mechanical Engineering, Colorado State University, Fort Collins, CO, USA
| | - Ethan Walker
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, CO, USA
| | - Ander Wilson
- Department of Statistics, Colorado State University, Fort Collins, CO, USA
| | - John Balmes
- Department of Medicine, University of California, San Francisco, CA, USA
| | - Robert D Brook
- Division of Cardiovascular Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Maggie L Clark
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, CO, USA
| | - Robert B Devlin
- Environmental Public Health Division, United States Environmental Protection Agency, Chapel Hill, NC, USA
| | - John Volckens
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, CO, USA; Department of Mechanical Engineering, Colorado State University, Fort Collins, CO, USA
| | - Jennifer L Peel
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, CO, USA
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23
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Benka-Coker W, Hoskovec L, Severson R, Balmes J, Wilson A, Magzamen S. The joint effect of ambient air pollution and agricultural pesticide exposures on lung function among children with asthma. Environ Res 2020; 190:109903. [PMID: 32750551 PMCID: PMC7529969 DOI: 10.1016/j.envres.2020.109903] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [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: 02/10/2020] [Revised: 06/21/2020] [Accepted: 06/30/2020] [Indexed: 05/02/2023]
Abstract
BACKGROUND Ambient environmental pollutants have been shown to adversely affect respiratory health in susceptible populations. However, the role of simultaneous exposure to multiple diverse environmental pollutants is poorly understood. OBJECTIVE We applied a multidomain, multipollutant approach to assess the association between pediatric lung function measures and selected ambient air pollutants and pesticides. METHODS Using data from the US EPA and California Pesticide Use Registry, we reconstructed three months prior exposure to ambient air pollutants ((ozone (O3), nitrogen dioxide (NO2), particulate matter with a median aerodynamic diameter < 2.5 μm (PM2.5) and <10 μm (PM10)) and pesticides (organophosphates (OP), carbamates (C) and methyl bromide (MeBr)) for 153 children with mild intermittent or mild persistent asthma from the San Joaquin Valley of California, USA. We implemented Bayesian kernel machine regression (BKMR) to estimate the association between simultaneous exposures to air pollutants and pesticides and lung function measures (forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC), and forced expiratory flow between 25% and 75% of vital capacity (FEF25-75)). RESULTS In BKMR analysis, the overall effect of mixtures (pollutants and pesticides) was associated with reduced FEV1 and FVC, particularly when all the environmental exposures were above their 60th percentile. For example, the effect of the overall mixture at the 70th percentile (compared to the median) was a -0.12SD (-50 mL, 95% CI: -180 mL, 90 mL) change in the FEV1 and a -0.18SD (-90 mL, 95% CI: -240 mL, 60 mL) change in the FVC. However, 95% credible intervals around all of the joint effect estimates contained the null value. CONCLUSION At this agricultural-urban interface, we observed results from multipollutant analyses, suggestive of adverse effects on some pediatric lung function measures following a cumulative increase in ambient air pollutants and agricultural pesticides. Given the uncertainty in effect estimates, this approach should be explored in larger studies.
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Affiliation(s)
- Wande Benka-Coker
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, CO, USA.
| | - Lauren Hoskovec
- Department of Statistics, Colorado State University, Fort Collins, CO, USA
| | - Rachel Severson
- Colorado Department of Public Health and Environment; Denver, Colorado, USA
| | - John Balmes
- Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley, CA, USA
| | - Ander Wilson
- Department of Statistics, Colorado State University, Fort Collins, CO, USA
| | - Sheryl Magzamen
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, CO, USA
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24
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Frey HC, Adams PJ, Adgate JL, Allen GA, Balmes J, Boyle K, Chow JC, Dockery DW, Felton HD, Gordon T, Harkema JR, Kinney P, Kleinman MT, McConnell R, Poirot RL, Sarnat JA, Sheppard L, Turpin B, Wyzga R. The Need for a Tighter Particulate-Matter Air-Quality Standard. N Engl J Med 2020; 383:680-683. [PMID: 32521130 DOI: 10.1056/nejmsb2011009] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- H Christopher Frey
- The affiliations of the members of the writing committee are as follows: North Carolina State University, Raleigh (H.C.F.), and the University of North Carolina Gillings School of Global Public Health, Chapel Hill (B.T.); Carnegie Mellon University, Pittsburgh (P.J.A.); Colorado School of Public Health, Aurora (J.L.A.); Northeast States for Coordinated Air Use Management (G.A.A.), Harvard University T.H. Chan School of Public Health (D.W.D.), and Boston University (P.K.) - all in Boston; Lung Biology Center, University of California, San Francisco, San Francisco (J.B.), University of California, Irvine, Irvine (M.T.K.), University of Southern California Keck School of Medicine, Los Angeles (R.M.), and retired, Palo Alto (R.W.) - all in California; Virginia Tech, Blacksburg (K.B.); Desert Research Institute, Reno, NV (J.C.C.); New York State Department of Environmental Conservation, Albany (H.D.F.), and New York University Langone Health, New York (T.G.); Michigan State University, East Lansing (J.R.H.); independent consultant, Burlington, VT (R.L.P.); Rollins School of Public Health, Atlanta (J.A.S.); and University of Washington, Seattle (L.S.)
| | - Peter J Adams
- The affiliations of the members of the writing committee are as follows: North Carolina State University, Raleigh (H.C.F.), and the University of North Carolina Gillings School of Global Public Health, Chapel Hill (B.T.); Carnegie Mellon University, Pittsburgh (P.J.A.); Colorado School of Public Health, Aurora (J.L.A.); Northeast States for Coordinated Air Use Management (G.A.A.), Harvard University T.H. Chan School of Public Health (D.W.D.), and Boston University (P.K.) - all in Boston; Lung Biology Center, University of California, San Francisco, San Francisco (J.B.), University of California, Irvine, Irvine (M.T.K.), University of Southern California Keck School of Medicine, Los Angeles (R.M.), and retired, Palo Alto (R.W.) - all in California; Virginia Tech, Blacksburg (K.B.); Desert Research Institute, Reno, NV (J.C.C.); New York State Department of Environmental Conservation, Albany (H.D.F.), and New York University Langone Health, New York (T.G.); Michigan State University, East Lansing (J.R.H.); independent consultant, Burlington, VT (R.L.P.); Rollins School of Public Health, Atlanta (J.A.S.); and University of Washington, Seattle (L.S.)
| | - John L Adgate
- The affiliations of the members of the writing committee are as follows: North Carolina State University, Raleigh (H.C.F.), and the University of North Carolina Gillings School of Global Public Health, Chapel Hill (B.T.); Carnegie Mellon University, Pittsburgh (P.J.A.); Colorado School of Public Health, Aurora (J.L.A.); Northeast States for Coordinated Air Use Management (G.A.A.), Harvard University T.H. Chan School of Public Health (D.W.D.), and Boston University (P.K.) - all in Boston; Lung Biology Center, University of California, San Francisco, San Francisco (J.B.), University of California, Irvine, Irvine (M.T.K.), University of Southern California Keck School of Medicine, Los Angeles (R.M.), and retired, Palo Alto (R.W.) - all in California; Virginia Tech, Blacksburg (K.B.); Desert Research Institute, Reno, NV (J.C.C.); New York State Department of Environmental Conservation, Albany (H.D.F.), and New York University Langone Health, New York (T.G.); Michigan State University, East Lansing (J.R.H.); independent consultant, Burlington, VT (R.L.P.); Rollins School of Public Health, Atlanta (J.A.S.); and University of Washington, Seattle (L.S.)
| | - George A Allen
- The affiliations of the members of the writing committee are as follows: North Carolina State University, Raleigh (H.C.F.), and the University of North Carolina Gillings School of Global Public Health, Chapel Hill (B.T.); Carnegie Mellon University, Pittsburgh (P.J.A.); Colorado School of Public Health, Aurora (J.L.A.); Northeast States for Coordinated Air Use Management (G.A.A.), Harvard University T.H. Chan School of Public Health (D.W.D.), and Boston University (P.K.) - all in Boston; Lung Biology Center, University of California, San Francisco, San Francisco (J.B.), University of California, Irvine, Irvine (M.T.K.), University of Southern California Keck School of Medicine, Los Angeles (R.M.), and retired, Palo Alto (R.W.) - all in California; Virginia Tech, Blacksburg (K.B.); Desert Research Institute, Reno, NV (J.C.C.); New York State Department of Environmental Conservation, Albany (H.D.F.), and New York University Langone Health, New York (T.G.); Michigan State University, East Lansing (J.R.H.); independent consultant, Burlington, VT (R.L.P.); Rollins School of Public Health, Atlanta (J.A.S.); and University of Washington, Seattle (L.S.)
| | - John Balmes
- The affiliations of the members of the writing committee are as follows: North Carolina State University, Raleigh (H.C.F.), and the University of North Carolina Gillings School of Global Public Health, Chapel Hill (B.T.); Carnegie Mellon University, Pittsburgh (P.J.A.); Colorado School of Public Health, Aurora (J.L.A.); Northeast States for Coordinated Air Use Management (G.A.A.), Harvard University T.H. Chan School of Public Health (D.W.D.), and Boston University (P.K.) - all in Boston; Lung Biology Center, University of California, San Francisco, San Francisco (J.B.), University of California, Irvine, Irvine (M.T.K.), University of Southern California Keck School of Medicine, Los Angeles (R.M.), and retired, Palo Alto (R.W.) - all in California; Virginia Tech, Blacksburg (K.B.); Desert Research Institute, Reno, NV (J.C.C.); New York State Department of Environmental Conservation, Albany (H.D.F.), and New York University Langone Health, New York (T.G.); Michigan State University, East Lansing (J.R.H.); independent consultant, Burlington, VT (R.L.P.); Rollins School of Public Health, Atlanta (J.A.S.); and University of Washington, Seattle (L.S.)
| | - Kevin Boyle
- The affiliations of the members of the writing committee are as follows: North Carolina State University, Raleigh (H.C.F.), and the University of North Carolina Gillings School of Global Public Health, Chapel Hill (B.T.); Carnegie Mellon University, Pittsburgh (P.J.A.); Colorado School of Public Health, Aurora (J.L.A.); Northeast States for Coordinated Air Use Management (G.A.A.), Harvard University T.H. Chan School of Public Health (D.W.D.), and Boston University (P.K.) - all in Boston; Lung Biology Center, University of California, San Francisco, San Francisco (J.B.), University of California, Irvine, Irvine (M.T.K.), University of Southern California Keck School of Medicine, Los Angeles (R.M.), and retired, Palo Alto (R.W.) - all in California; Virginia Tech, Blacksburg (K.B.); Desert Research Institute, Reno, NV (J.C.C.); New York State Department of Environmental Conservation, Albany (H.D.F.), and New York University Langone Health, New York (T.G.); Michigan State University, East Lansing (J.R.H.); independent consultant, Burlington, VT (R.L.P.); Rollins School of Public Health, Atlanta (J.A.S.); and University of Washington, Seattle (L.S.)
| | - Judith C Chow
- The affiliations of the members of the writing committee are as follows: North Carolina State University, Raleigh (H.C.F.), and the University of North Carolina Gillings School of Global Public Health, Chapel Hill (B.T.); Carnegie Mellon University, Pittsburgh (P.J.A.); Colorado School of Public Health, Aurora (J.L.A.); Northeast States for Coordinated Air Use Management (G.A.A.), Harvard University T.H. Chan School of Public Health (D.W.D.), and Boston University (P.K.) - all in Boston; Lung Biology Center, University of California, San Francisco, San Francisco (J.B.), University of California, Irvine, Irvine (M.T.K.), University of Southern California Keck School of Medicine, Los Angeles (R.M.), and retired, Palo Alto (R.W.) - all in California; Virginia Tech, Blacksburg (K.B.); Desert Research Institute, Reno, NV (J.C.C.); New York State Department of Environmental Conservation, Albany (H.D.F.), and New York University Langone Health, New York (T.G.); Michigan State University, East Lansing (J.R.H.); independent consultant, Burlington, VT (R.L.P.); Rollins School of Public Health, Atlanta (J.A.S.); and University of Washington, Seattle (L.S.)
| | - Douglas W Dockery
- The affiliations of the members of the writing committee are as follows: North Carolina State University, Raleigh (H.C.F.), and the University of North Carolina Gillings School of Global Public Health, Chapel Hill (B.T.); Carnegie Mellon University, Pittsburgh (P.J.A.); Colorado School of Public Health, Aurora (J.L.A.); Northeast States for Coordinated Air Use Management (G.A.A.), Harvard University T.H. Chan School of Public Health (D.W.D.), and Boston University (P.K.) - all in Boston; Lung Biology Center, University of California, San Francisco, San Francisco (J.B.), University of California, Irvine, Irvine (M.T.K.), University of Southern California Keck School of Medicine, Los Angeles (R.M.), and retired, Palo Alto (R.W.) - all in California; Virginia Tech, Blacksburg (K.B.); Desert Research Institute, Reno, NV (J.C.C.); New York State Department of Environmental Conservation, Albany (H.D.F.), and New York University Langone Health, New York (T.G.); Michigan State University, East Lansing (J.R.H.); independent consultant, Burlington, VT (R.L.P.); Rollins School of Public Health, Atlanta (J.A.S.); and University of Washington, Seattle (L.S.)
| | - Henry D Felton
- The affiliations of the members of the writing committee are as follows: North Carolina State University, Raleigh (H.C.F.), and the University of North Carolina Gillings School of Global Public Health, Chapel Hill (B.T.); Carnegie Mellon University, Pittsburgh (P.J.A.); Colorado School of Public Health, Aurora (J.L.A.); Northeast States for Coordinated Air Use Management (G.A.A.), Harvard University T.H. Chan School of Public Health (D.W.D.), and Boston University (P.K.) - all in Boston; Lung Biology Center, University of California, San Francisco, San Francisco (J.B.), University of California, Irvine, Irvine (M.T.K.), University of Southern California Keck School of Medicine, Los Angeles (R.M.), and retired, Palo Alto (R.W.) - all in California; Virginia Tech, Blacksburg (K.B.); Desert Research Institute, Reno, NV (J.C.C.); New York State Department of Environmental Conservation, Albany (H.D.F.), and New York University Langone Health, New York (T.G.); Michigan State University, East Lansing (J.R.H.); independent consultant, Burlington, VT (R.L.P.); Rollins School of Public Health, Atlanta (J.A.S.); and University of Washington, Seattle (L.S.)
| | - Terry Gordon
- The affiliations of the members of the writing committee are as follows: North Carolina State University, Raleigh (H.C.F.), and the University of North Carolina Gillings School of Global Public Health, Chapel Hill (B.T.); Carnegie Mellon University, Pittsburgh (P.J.A.); Colorado School of Public Health, Aurora (J.L.A.); Northeast States for Coordinated Air Use Management (G.A.A.), Harvard University T.H. Chan School of Public Health (D.W.D.), and Boston University (P.K.) - all in Boston; Lung Biology Center, University of California, San Francisco, San Francisco (J.B.), University of California, Irvine, Irvine (M.T.K.), University of Southern California Keck School of Medicine, Los Angeles (R.M.), and retired, Palo Alto (R.W.) - all in California; Virginia Tech, Blacksburg (K.B.); Desert Research Institute, Reno, NV (J.C.C.); New York State Department of Environmental Conservation, Albany (H.D.F.), and New York University Langone Health, New York (T.G.); Michigan State University, East Lansing (J.R.H.); independent consultant, Burlington, VT (R.L.P.); Rollins School of Public Health, Atlanta (J.A.S.); and University of Washington, Seattle (L.S.)
| | - Jack R Harkema
- The affiliations of the members of the writing committee are as follows: North Carolina State University, Raleigh (H.C.F.), and the University of North Carolina Gillings School of Global Public Health, Chapel Hill (B.T.); Carnegie Mellon University, Pittsburgh (P.J.A.); Colorado School of Public Health, Aurora (J.L.A.); Northeast States for Coordinated Air Use Management (G.A.A.), Harvard University T.H. Chan School of Public Health (D.W.D.), and Boston University (P.K.) - all in Boston; Lung Biology Center, University of California, San Francisco, San Francisco (J.B.), University of California, Irvine, Irvine (M.T.K.), University of Southern California Keck School of Medicine, Los Angeles (R.M.), and retired, Palo Alto (R.W.) - all in California; Virginia Tech, Blacksburg (K.B.); Desert Research Institute, Reno, NV (J.C.C.); New York State Department of Environmental Conservation, Albany (H.D.F.), and New York University Langone Health, New York (T.G.); Michigan State University, East Lansing (J.R.H.); independent consultant, Burlington, VT (R.L.P.); Rollins School of Public Health, Atlanta (J.A.S.); and University of Washington, Seattle (L.S.)
| | - Patrick Kinney
- The affiliations of the members of the writing committee are as follows: North Carolina State University, Raleigh (H.C.F.), and the University of North Carolina Gillings School of Global Public Health, Chapel Hill (B.T.); Carnegie Mellon University, Pittsburgh (P.J.A.); Colorado School of Public Health, Aurora (J.L.A.); Northeast States for Coordinated Air Use Management (G.A.A.), Harvard University T.H. Chan School of Public Health (D.W.D.), and Boston University (P.K.) - all in Boston; Lung Biology Center, University of California, San Francisco, San Francisco (J.B.), University of California, Irvine, Irvine (M.T.K.), University of Southern California Keck School of Medicine, Los Angeles (R.M.), and retired, Palo Alto (R.W.) - all in California; Virginia Tech, Blacksburg (K.B.); Desert Research Institute, Reno, NV (J.C.C.); New York State Department of Environmental Conservation, Albany (H.D.F.), and New York University Langone Health, New York (T.G.); Michigan State University, East Lansing (J.R.H.); independent consultant, Burlington, VT (R.L.P.); Rollins School of Public Health, Atlanta (J.A.S.); and University of Washington, Seattle (L.S.)
| | - Michael T Kleinman
- The affiliations of the members of the writing committee are as follows: North Carolina State University, Raleigh (H.C.F.), and the University of North Carolina Gillings School of Global Public Health, Chapel Hill (B.T.); Carnegie Mellon University, Pittsburgh (P.J.A.); Colorado School of Public Health, Aurora (J.L.A.); Northeast States for Coordinated Air Use Management (G.A.A.), Harvard University T.H. Chan School of Public Health (D.W.D.), and Boston University (P.K.) - all in Boston; Lung Biology Center, University of California, San Francisco, San Francisco (J.B.), University of California, Irvine, Irvine (M.T.K.), University of Southern California Keck School of Medicine, Los Angeles (R.M.), and retired, Palo Alto (R.W.) - all in California; Virginia Tech, Blacksburg (K.B.); Desert Research Institute, Reno, NV (J.C.C.); New York State Department of Environmental Conservation, Albany (H.D.F.), and New York University Langone Health, New York (T.G.); Michigan State University, East Lansing (J.R.H.); independent consultant, Burlington, VT (R.L.P.); Rollins School of Public Health, Atlanta (J.A.S.); and University of Washington, Seattle (L.S.)
| | - Rob McConnell
- The affiliations of the members of the writing committee are as follows: North Carolina State University, Raleigh (H.C.F.), and the University of North Carolina Gillings School of Global Public Health, Chapel Hill (B.T.); Carnegie Mellon University, Pittsburgh (P.J.A.); Colorado School of Public Health, Aurora (J.L.A.); Northeast States for Coordinated Air Use Management (G.A.A.), Harvard University T.H. Chan School of Public Health (D.W.D.), and Boston University (P.K.) - all in Boston; Lung Biology Center, University of California, San Francisco, San Francisco (J.B.), University of California, Irvine, Irvine (M.T.K.), University of Southern California Keck School of Medicine, Los Angeles (R.M.), and retired, Palo Alto (R.W.) - all in California; Virginia Tech, Blacksburg (K.B.); Desert Research Institute, Reno, NV (J.C.C.); New York State Department of Environmental Conservation, Albany (H.D.F.), and New York University Langone Health, New York (T.G.); Michigan State University, East Lansing (J.R.H.); independent consultant, Burlington, VT (R.L.P.); Rollins School of Public Health, Atlanta (J.A.S.); and University of Washington, Seattle (L.S.)
| | - Richard L Poirot
- The affiliations of the members of the writing committee are as follows: North Carolina State University, Raleigh (H.C.F.), and the University of North Carolina Gillings School of Global Public Health, Chapel Hill (B.T.); Carnegie Mellon University, Pittsburgh (P.J.A.); Colorado School of Public Health, Aurora (J.L.A.); Northeast States for Coordinated Air Use Management (G.A.A.), Harvard University T.H. Chan School of Public Health (D.W.D.), and Boston University (P.K.) - all in Boston; Lung Biology Center, University of California, San Francisco, San Francisco (J.B.), University of California, Irvine, Irvine (M.T.K.), University of Southern California Keck School of Medicine, Los Angeles (R.M.), and retired, Palo Alto (R.W.) - all in California; Virginia Tech, Blacksburg (K.B.); Desert Research Institute, Reno, NV (J.C.C.); New York State Department of Environmental Conservation, Albany (H.D.F.), and New York University Langone Health, New York (T.G.); Michigan State University, East Lansing (J.R.H.); independent consultant, Burlington, VT (R.L.P.); Rollins School of Public Health, Atlanta (J.A.S.); and University of Washington, Seattle (L.S.)
| | - Jeremy A Sarnat
- The affiliations of the members of the writing committee are as follows: North Carolina State University, Raleigh (H.C.F.), and the University of North Carolina Gillings School of Global Public Health, Chapel Hill (B.T.); Carnegie Mellon University, Pittsburgh (P.J.A.); Colorado School of Public Health, Aurora (J.L.A.); Northeast States for Coordinated Air Use Management (G.A.A.), Harvard University T.H. Chan School of Public Health (D.W.D.), and Boston University (P.K.) - all in Boston; Lung Biology Center, University of California, San Francisco, San Francisco (J.B.), University of California, Irvine, Irvine (M.T.K.), University of Southern California Keck School of Medicine, Los Angeles (R.M.), and retired, Palo Alto (R.W.) - all in California; Virginia Tech, Blacksburg (K.B.); Desert Research Institute, Reno, NV (J.C.C.); New York State Department of Environmental Conservation, Albany (H.D.F.), and New York University Langone Health, New York (T.G.); Michigan State University, East Lansing (J.R.H.); independent consultant, Burlington, VT (R.L.P.); Rollins School of Public Health, Atlanta (J.A.S.); and University of Washington, Seattle (L.S.)
| | - Lianne Sheppard
- The affiliations of the members of the writing committee are as follows: North Carolina State University, Raleigh (H.C.F.), and the University of North Carolina Gillings School of Global Public Health, Chapel Hill (B.T.); Carnegie Mellon University, Pittsburgh (P.J.A.); Colorado School of Public Health, Aurora (J.L.A.); Northeast States for Coordinated Air Use Management (G.A.A.), Harvard University T.H. Chan School of Public Health (D.W.D.), and Boston University (P.K.) - all in Boston; Lung Biology Center, University of California, San Francisco, San Francisco (J.B.), University of California, Irvine, Irvine (M.T.K.), University of Southern California Keck School of Medicine, Los Angeles (R.M.), and retired, Palo Alto (R.W.) - all in California; Virginia Tech, Blacksburg (K.B.); Desert Research Institute, Reno, NV (J.C.C.); New York State Department of Environmental Conservation, Albany (H.D.F.), and New York University Langone Health, New York (T.G.); Michigan State University, East Lansing (J.R.H.); independent consultant, Burlington, VT (R.L.P.); Rollins School of Public Health, Atlanta (J.A.S.); and University of Washington, Seattle (L.S.)
| | - Barbara Turpin
- The affiliations of the members of the writing committee are as follows: North Carolina State University, Raleigh (H.C.F.), and the University of North Carolina Gillings School of Global Public Health, Chapel Hill (B.T.); Carnegie Mellon University, Pittsburgh (P.J.A.); Colorado School of Public Health, Aurora (J.L.A.); Northeast States for Coordinated Air Use Management (G.A.A.), Harvard University T.H. Chan School of Public Health (D.W.D.), and Boston University (P.K.) - all in Boston; Lung Biology Center, University of California, San Francisco, San Francisco (J.B.), University of California, Irvine, Irvine (M.T.K.), University of Southern California Keck School of Medicine, Los Angeles (R.M.), and retired, Palo Alto (R.W.) - all in California; Virginia Tech, Blacksburg (K.B.); Desert Research Institute, Reno, NV (J.C.C.); New York State Department of Environmental Conservation, Albany (H.D.F.), and New York University Langone Health, New York (T.G.); Michigan State University, East Lansing (J.R.H.); independent consultant, Burlington, VT (R.L.P.); Rollins School of Public Health, Atlanta (J.A.S.); and University of Washington, Seattle (L.S.)
| | - Ron Wyzga
- The affiliations of the members of the writing committee are as follows: North Carolina State University, Raleigh (H.C.F.), and the University of North Carolina Gillings School of Global Public Health, Chapel Hill (B.T.); Carnegie Mellon University, Pittsburgh (P.J.A.); Colorado School of Public Health, Aurora (J.L.A.); Northeast States for Coordinated Air Use Management (G.A.A.), Harvard University T.H. Chan School of Public Health (D.W.D.), and Boston University (P.K.) - all in Boston; Lung Biology Center, University of California, San Francisco, San Francisco (J.B.), University of California, Irvine, Irvine (M.T.K.), University of Southern California Keck School of Medicine, Los Angeles (R.M.), and retired, Palo Alto (R.W.) - all in California; Virginia Tech, Blacksburg (K.B.); Desert Research Institute, Reno, NV (J.C.C.); New York State Department of Environmental Conservation, Albany (H.D.F.), and New York University Langone Health, New York (T.G.); Michigan State University, East Lansing (J.R.H.); independent consultant, Burlington, VT (R.L.P.); Rollins School of Public Health, Atlanta (J.A.S.); and University of Washington, Seattle (L.S.)
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25
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Berger K, Coker E, Rauch S, Eskenazi B, Balmes J, Kogut K, Holland N, Calafat AM, Harley K. Prenatal phthalate, paraben, and phenol exposure and childhood allergic and respiratory outcomes: Evaluating exposure to chemical mixtures. Sci Total Environ 2020; 725:138418. [PMID: 32302842 PMCID: PMC7255953 DOI: 10.1016/j.scitotenv.2020.138418] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [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: 01/28/2020] [Revised: 03/31/2020] [Accepted: 04/01/2020] [Indexed: 05/10/2023]
Abstract
BACKGROUND Chemicals found in personal care products and plastics have been associated with asthma, allergies, and lung function, but methods to address real life exposure to mixtures of these chemicals have not been applied to these associations. METHODS We quantified urinary concentrations of eleven phthalate metabolites, four parabens, and five other phenols in mothers twice during pregnancy and assessed probable asthma, aeroallergies, and lung function in their age seven children. We implemented Bayesian Profile Regression (BPR) to cluster women by their exposures to these chemicals and tested the clusters for differences in outcome measurements. We used Bayesian Kernel Machine Regression (BKMR) to fit biomarkers into one model as joint independent variables. RESULTS BPR clustered women into seven groups characterized by patterns of personal care product and plastic use, though there were no significant differences in outcomes across clusters. BKMR showed that monocarboxyisooctyl phthalate and 2,4-dichlorophenol were associated with probable asthma (predicted probability of probable asthma per IQR of biomarker z-score (standard deviation) = 0.08 (0.09) and 0.11 (0.12), respectively) and poorer lung function (predicted probability per IQR = -0.07 (0.05) and -0.07 (0.06), respectively), and that mono(3-carboxypropyl) phthalate and bisphenol A were associated with aeroallergies (predicted probability per IQR = 0.13 (0.09) and 0.11 (0.08), respectively). Several biomarkers demonstrated positive additive effects on other associations. CONCLUSIONS BPR and BKMR are useful tools to evaluate associations of biomarker concentrations within a mixture of exposure and should supplement single-chemical regression models when data allow.
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Affiliation(s)
- Kimberly Berger
- Center for Environmental Research and Children's Health (CERCH), School of Public Health, University of California, Berkeley, 1995 University Avenue, Berkeley, CA 94704, USA.
| | - Eric Coker
- Center for Environmental Research and Children's Health (CERCH), School of Public Health, University of California, Berkeley, 1995 University Avenue, Berkeley, CA 94704, USA.
| | - Stephen Rauch
- Center for Environmental Research and Children's Health (CERCH), School of Public Health, University of California, Berkeley, 1995 University Avenue, Berkeley, CA 94704, USA.
| | - Brenda Eskenazi
- Center for Environmental Research and Children's Health (CERCH), School of Public Health, University of California, Berkeley, 1995 University Avenue, Berkeley, CA 94704, USA.
| | - John Balmes
- Center for Environmental Research and Children's Health (CERCH), School of Public Health, University of California, Berkeley, 1995 University Avenue, Berkeley, CA 94704, USA.
| | - Katie Kogut
- Center for Environmental Research and Children's Health (CERCH), School of Public Health, University of California, Berkeley, 1995 University Avenue, Berkeley, CA 94704, USA.
| | - Nina Holland
- Center for Environmental Research and Children's Health (CERCH), School of Public Health, University of California, Berkeley, 1995 University Avenue, Berkeley, CA 94704, USA.
| | - Antonia M Calafat
- Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, 4770 Buford Hwy, Atlanta, GA 30341, USA.
| | - Kim Harley
- Center for Environmental Research and Children's Health (CERCH), School of Public Health, University of California, Berkeley, 1995 University Avenue, Berkeley, CA 94704, USA.
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26
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Fadadu R, Grimes B, Balmes J, Wei M. 413 Wildfire-associated air pollution impacts clinic visits for itch and atopic dermatitis. J Invest Dermatol 2020. [DOI: 10.1016/j.jid.2020.03.421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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27
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Mortimer K, Lesosky M, Semple S, Malava J, Katundu C, Crampin A, Wang D, Weston W, Pope D, Havens D, Gordon SB, Balmes J. Pneumonia and Exposure to Household Air Pollution in Children Under the Age of 5 Years in Rural Malawi: Findings From the Cooking and Pneumonia Study. Chest 2020; 158:501-511. [PMID: 32311349 PMCID: PMC7417377 DOI: 10.1016/j.chest.2020.03.064] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [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: 12/09/2019] [Revised: 03/16/2020] [Accepted: 03/28/2020] [Indexed: 01/06/2023] Open
Abstract
Background Exposure to household air pollution is associated with an increased risk of pneumonia in children in low- and middle-income countries; however, exposure-response data are limited, and there are uncertainties around the extent to which biomass-fueled cookstoves can reduce these exposures. Research Question What is the association between exposure to household air pollution and pneumonia in children under the age of 5 years in rural Malawi and what are the effects of a biomass-fueled cookstove intervention on personal exposure to household air pollution? Study Design and Methods We measured personal exposure to carbon monoxide (CO; 48 hours of continuous measurement and transcutaneous carboxyhemoglobin) every 6 months in children who participated in a cluster-randomized controlled trial of a cleaner burning biomass-fueled cookstove intervention to prevent pneumonia in children under the age of 5 years in rural Malawi (the Cooking And Pneumonia Study). Exposure-response and multivariable analyses were done. Results We recruited 1805 (928 intervention; 877 control) children (mean age, 25.6 months; 50.6% female). We found no evidence of an association between exposure to CO (incident rate ratio, 1.0; 95% CI, 0.967 to 1.014; P = .53) or carboxyhemoglobin (incident rate ratio, 1.00; 95% CI, 0.993 to 1.003; P = .41) in children who experienced pneumonia vs those who did not. Median exposure to CO in the intervention and control groups was was 0.34 (interquartile range, 0.15 to 0.81) and 0.37 parts per million (interquartile range, 0.15 toa 0.97), respectively. The group difference in means was 0.46 (95% CI, −0.95 to 0.012; P = .06). Interpretation Exposure to CO in our population was low with no association seen between exposure to CO and pneumonia incidence and no effect of the Cooking And Pneumonia Study intervention on these exposures. These findings suggest that CO may not be an appropriate measure of household air pollution exposure in settings such as rural Malawi and that there is a need to develop ways to measure particulate matter exposures directly in young children instead. Clinical Trial Registration ISRCTN59448623.
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Affiliation(s)
| | - Maia Lesosky
- University of Cape Town, Cape Town, South Africa
| | | | - Jullita Malava
- Malawi Epidemiology and Intervention Research Unit, Chilumba, Malawi
| | - Cynthia Katundu
- Malawi Epidemiology and Intervention Research Unit, Chilumba, Malawi
| | - Amelia Crampin
- Malawi Epidemiology and Intervention Research Unit, Chilumba, Malawi; London School of Hygiene and Tropical Medicine, London, UK
| | - Duolao Wang
- Liverpool School of Tropical Medicine, Liverpool, UK
| | | | - Dan Pope
- University of Liverpool, Liverpool, UK
| | | | - Stephen B Gordon
- Liverpool School of Tropical Medicine, Liverpool, UK; Malawi Liverpool Wellcome Trust Programme, Blantyre, Malawi
| | - John Balmes
- University of California, Berkeley, CA; University of California, San Francisco, San Francisco, CA
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28
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Fedak KM, Good N, Walker ES, Balmes J, Brook RD, Clark ML, Cole-Hunter T, Devlin R, L'Orange C, Luckasen G, Mehaffy J, Shelton R, Wilson A, Volckens J, Peel JL. Acute changes in lung function following controlled exposure to cookstove air pollution in the subclinical tests of volunteers exposed to smoke (STOVES) study. Inhal Toxicol 2020; 32:115-123. [PMID: 32297528 DOI: 10.1080/08958378.2020.1751750] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Background: Exposure to household air pollution generated as a result of cooking and heating is a leading contributor to global disease. The effects of cookstove-generated air pollution on adult lung function, however, remain uncertain.Objectives: We investigated acute responses in lung function following controlled exposures to cookstove-generated air pollution.Methods: We recruited 48 healthy adult volunteers to undergo six two-hour treatments: a filtered-air control and emissions from five different stoves with fine particulate matter (PM2.5) targets from 10 to 500 µg/m3. Spirometry was conducted prior to exposure and immediately, and three and 24 h post-exposure. Mixed-effect models were used to estimate differences in post-exposure lung function for stove treatments versus control.Results: Immediately post-exposure, lung function was lower compared to the control for the three highest PM2.5-level stoves. The largest differences were for the fan rocket stove (target 250 µg/m3; forced vital capacity (FVC): -60 mL, 95% confidence interval (95% CI) -135, 15; forced expiratory volume (FEV1): -51 mL, 95% CI -117, 16; mid-expiratory flow (FEF25-75): -116 mL/s, 95% CI -239, 8). At 3 h post-exposure, lung function was lower compared to the control for all stove treatments; effects were of similar magnitude for all stoves. At 24 h post-exposure, results were consistent with a null association for FVC and FEV1; FEF25-75 was lower relative to the control for the gasifier, fan rocket, and three stone fire.Conclusions: Patterns suggesting short-term decreases in lung function follow from exposure to cookstove air pollution even for stove exposures with low PM2.5 levels.
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Affiliation(s)
- Kristen M Fedak
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, CO, USA
| | - Nicholas Good
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, CO, USA
| | - Ethan S Walker
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, CO, USA
| | - John Balmes
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Robert D Brook
- Division of Cardiovascular Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Maggie L Clark
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, CO, USA
| | - Tom Cole-Hunter
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, CO, USA.,Centre for Air pollution, energy, and health Research, University of New South Wales, Sydney, Australia.,International Laboratory for Air Quality and Health, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia.,Science and Engineering Faculty, Queensland University of Technology, Brisbane, Australia
| | - Robert Devlin
- Environmental Public Health Division, United States Environmental Protection Agency, Durham, NC, USA
| | - Christian L'Orange
- Department of Mechanical Engineering, Colorado State University, Fort Collins, CO, USA
| | | | - John Mehaffy
- Department of Mechanical Engineering, Colorado State University, Fort Collins, CO, USA
| | - Rhiannon Shelton
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, CO, USA
| | - Ander Wilson
- Department of Statistics, Colorado State University, Fort Collins, CO, USA
| | - John Volckens
- Department of Mechanical Engineering, Colorado State University, Fort Collins, CO, USA
| | - Jennifer L Peel
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, CO, USA
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29
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Blount RJ, Pascopella L, Barry P, Zabner J, Stapleton EM, Flood J, Balmes J, Nahid P, Catanzaro DG. Residential urban tree canopy is associated with decreased mortality during tuberculosis treatment in California. Sci Total Environ 2020; 711:134580. [PMID: 32000313 PMCID: PMC6995452 DOI: 10.1016/j.scitotenv.2019.134580] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 08/02/2019] [Revised: 09/18/2019] [Accepted: 09/19/2019] [Indexed: 06/10/2023]
Abstract
Trees can sequester air pollutants, and air pollution is associated with poor tuberculosis outcomes. However, the health impacts of urban trees on tuberculosis patients are unknown. To elucidate the effects of urban tree canopy on mortality during tuberculosis treatment, we evaluated patients diagnosed with active tuberculosis in California from 2000 through 2012, obtaining patient data from the California tuberculosis registry. Our primary outcome was all-cause mortality during tuberculosis treatment. We determined percent tree cover using 1 mresolution color infrared orthoimagery categorized into land cover classes, then linked tree cover to four circular buffer zones of 50-300 m radii around patient residential addresses. We used the Kaplan-Meier method to estimate survival probabilities and Cox regression models to determine mortality hazard ratios, adjusting for demographic, socioeconomic, and clinical covariates. Our cohort included 33,962 tuberculosis patients of median age 47, 59% male, 51% unemployed, and 4.9% HIV positive. Tuberculosis was microbiologically confirmed in 79%, and 1.17% were multi-drug resistant (MDR). Median tree cover was 7.9% (50 m buffer). Patients were followed for 23,280 person-years with 2370 deaths during tuberculosis treatment resulting in a crude mortality rate of 1018 deaths per 10,000 person-years. Increasing tree cover quintiles were associated with decreasing mortality risk during tuberculosis treatment in all buffers, and the magnitude of association decreased incrementally with increasing buffer radius: In the 50 m buffer, patients living in neighborhoods with the highest quintile tree cover experienced a 22% reduction in mortality (HR 0.78, 95%CI 0.68-0.90) compared to those living in lowest quintile tree cover; whereas for 100, 200, and 300 m buffers, a 21%, 13%, and 11% mortality risk reduction was evident. In conclusion, urban tree canopy was associated with decreased mortality during tuberculosis treatment even after adjusting for multiple demographic, socioeconomic, and clinical factors, suggesting that trees might play a role in improving tuberculosis outcomes.
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Affiliation(s)
- Robert J Blount
- Division of Pulmonary and Critical Care Medicine, University of Iowa, Iowa City, IA, USA.
| | - Lisa Pascopella
- Tuberculosis Control Branch, California Department of Public Health, Richmond, CA, USA
| | - Pennan Barry
- Tuberculosis Control Branch, California Department of Public Health, Richmond, CA, USA
| | - Joseph Zabner
- Division of Pulmonary and Critical Care Medicine, University of Iowa, Iowa City, IA, USA
| | - Emma M Stapleton
- Division of Pulmonary and Critical Care Medicine, University of Iowa, Iowa City, IA, USA
| | - Jennifer Flood
- Tuberculosis Control Branch, California Department of Public Health, Richmond, CA, USA
| | - John Balmes
- Division of Pulmonary and Critical Care Medicine, University of California, San Francisco, CA, USA; Environmental Health Sciences, University of California, Berkeley, CA, USA
| | - Payam Nahid
- Division of Pulmonary and Critical Care Medicine, University of California, San Francisco, CA, USA
| | - Donald G Catanzaro
- Department of Biological Sciences, University of Arkansas, Fayetteville, AR, USA
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30
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Khan MA, Hira-Smith M, Ahmed SI, Yunus M, Hasan SMT, Liaw J, Balmes J, Raqib R, Yuan Y, Kalman D, Roh T, Steinmaus C, Smith AH. Prospective cohort study of respiratory effects at ages 14 to 26 following early life exposure to arsenic in drinking water. Environ Epidemiol 2020; 4:e089. [PMID: 32337474 PMCID: PMC7147401 DOI: 10.1097/ee9.0000000000000089] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 02/07/2020] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND We previously reported chronic respiratory effects in children who were then 7-17 years of age in Matlab, Bangladesh. One group of children had been exposed to high concentrations of arsenic in drinking water in utero and early childhood (average 436 µg/L), and the other group of children were never known to have been exposed to >10 µg/L. The exposed children, both males and females, had marked increases in chronic respiratory symptoms. METHODS The current study involves a further follow-up of these children now 14-26 years of age with 463 located and agreeing to participate. They were interviewed for respiratory symptoms and lung function was measured. Data were collected on smoking, body mass index (BMI), and number of rooms in the house as a measure of socioeconomic status. RESULTS Respiratory effects were still present in males but not females. In the high exposure group (>400 µg/L in early life) the odds ratio (OR) among male participants for dry cough in the last 12 months was 2.36 (95% confidence interval [CI] = 1.21, 4.63, P = 0.006) and for asthma OR = 2.51 (95% CI = 1.19, 5.29, P = 0.008). Forced vital capacity (FVC) was reduced in males in the early life high-exposure group compared with those never exposed (-95ml, P = 0.04), but not in female participants. CONCLUSIONS By the age range 14-26, there was little remaining evidence of chronic respiratory effects in females but pronounced effects persisted in males. Mechanisms for the marked male female differences warrant further investigation along with further follow-up to see if respiratory effects continue in males.
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Affiliation(s)
- Md Alfazal Khan
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Meera Hira-Smith
- Arsenic Health Effects Research Program, School of Public Health, University of California, Berkeley, California
| | - Syed Imran Ahmed
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Mohammad Yunus
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - S. M. Tafsir Hasan
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Jane Liaw
- Arsenic Health Effects Research Program, School of Public Health, University of California, Berkeley, California
| | - John Balmes
- Arsenic Health Effects Research Program, School of Public Health, University of California, Berkeley, California
- Department of Medicine, University of California, San Francisco, California
| | - Rubhana Raqib
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Yan Yuan
- Arsenic Health Effects Research Program, School of Public Health, University of California, Berkeley, California
| | - David Kalman
- Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington, Seattle, Washington
| | - Taehyun Roh
- Arsenic Health Effects Research Program, School of Public Health, University of California, Berkeley, California
| | - Craig Steinmaus
- Arsenic Health Effects Research Program, School of Public Health, University of California, Berkeley, California
- Office of Environmental Health Hazard Assessment, California Environmental Protection Agency, Oakland, California
| | - Allan H. Smith
- Arsenic Health Effects Research Program, School of Public Health, University of California, Berkeley, California
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31
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Kim JB, Prunicki M, Haddad F, Dant C, Sampath V, Patel R, Smith E, Akdis C, Balmes J, Snyder MP, Wu JC, Nadeau KC. Cumulative Lifetime Burden of Cardiovascular Disease From Early Exposure to Air Pollution. J Am Heart Assoc 2020; 9:e014944. [PMID: 32174249 PMCID: PMC7335506 DOI: 10.1161/jaha.119.014944] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The disease burden associated with air pollution continues to grow. The World Health Organization (WHO) estimates ≈7 million people worldwide die yearly from exposure to polluted air, half of which-3.3 million-are attributable to cardiovascular disease (CVD), greater than from major modifiable CVD risks including smoking, hypertension, hyperlipidemia, and diabetes mellitus. This serious and growing health threat is attributed to increasing urbanization of the world's populations with consequent exposure to polluted air. Especially vulnerable are the elderly, patients with pre-existing CVD, and children. The cumulative lifetime burden in children is particularly of concern because their rapidly developing cardiopulmonary systems are more susceptible to damage and they spend more time outdoors and therefore inhale more pollutants. World Health Organization estimates that 93% of the world's children aged <15 years-1.8 billion children-breathe air that puts their health and development at risk. Here, we present growing scientific evidence, including from our own group, that chronic exposure to air pollution early in life is directly linked to development of major CVD risks, including obesity, hypertension, and metabolic disorders. In this review, we surveyed the literature for current knowledge of how pollution exposure early in life adversely impacts cardiovascular phenotypes, and lay the foundation for early intervention and other strategies that can help prevent this damage. We also discuss the need for better guidelines and additional research to validate exposure metrics and interventions that will ultimately help healthcare providers reduce the growing burden of CVD from pollution.
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Affiliation(s)
- Juyong Brian Kim
- Division of Cardiovascular MedicineDepartment of MedicineStanford UniversityStanfordCA
- Stanford Cardiovascular InstituteStanford UniversityStanfordCA
| | - Mary Prunicki
- Sean N. Parker Center for Allergy and Asthma ResearchStanford UniversityStanfordCA
| | - Francois Haddad
- Division of Cardiovascular MedicineDepartment of MedicineStanford UniversityStanfordCA
- Stanford Cardiovascular InstituteStanford UniversityStanfordCA
| | - Christopher Dant
- Sean N. Parker Center for Allergy and Asthma ResearchStanford UniversityStanfordCA
| | - Vanitha Sampath
- Sean N. Parker Center for Allergy and Asthma ResearchStanford UniversityStanfordCA
| | - Rushali Patel
- Sean N. Parker Center for Allergy and Asthma ResearchStanford UniversityStanfordCA
| | - Eric Smith
- Sean N. Parker Center for Allergy and Asthma ResearchStanford UniversityStanfordCA
| | - Cezmi Akdis
- Swiss Institute for Allergy and Asthma Research (SIAF)University of ZurichDavosSwitzerland
| | - John Balmes
- Department of MedicineUniversity of California San Francisco and Division of Environmental Health SciencesSchool of Public HealthUniversity of California BerkeleyCA
| | - Michael P. Snyder
- Department of Genetics and Center for Genomics and Personalized MedicineStanford UniversityStanfordCA
| | - Joseph C. Wu
- Stanford Cardiovascular InstituteStanford UniversityStanfordCA
| | - Kari C. Nadeau
- Sean N. Parker Center for Allergy and Asthma ResearchStanford UniversityStanfordCA
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32
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Walker ES, Fedak KM, Good N, Balmes J, Brook RD, Clark ML, Cole-Hunter T, Dinenno F, Devlin RB, L'Orange C, Luckasen G, Mehaffy J, Shelton R, Wilson A, Volckens J, Peel JL. Acute differences in pulse wave velocity, augmentation index, and central pulse pressure following controlled exposures to cookstove air pollution in the Subclinical Tests of Volunteers Exposed to Smoke (SToVES) study. Environ Res 2020; 180:108831. [PMID: 31648072 PMCID: PMC6899199 DOI: 10.1016/j.envres.2019.108831] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 06/24/2019] [Revised: 10/15/2019] [Accepted: 10/16/2019] [Indexed: 05/24/2023]
Abstract
Household air pollution emitted from solid-fuel cookstoves used for domestic cooking is a leading risk factor for morbidity and premature mortality globally. There have been attempts to design and distribute lower emission cookstoves, yet it is unclear if they meaningfully improve health. Using a crossover design, we assessed differences in central aortic hemodynamics and arterial stiffness following controlled exposures to air pollution emitted from five different cookstove technologies compared to a filtered air control. Forty-eight young, healthy participants were assigned to six 2-h controlled treatments of pollution from five different cookstoves and a filtered air control. Each treatment had a target concentration for fine particulate matter: filtered air control = 0 μg/m3, liquefied petroleum gas = 10 μg/m3, gasifier = 35 μg/m3, fan rocket = 100 μg/m3, rocket elbow = 250 μg/m3, three stone fire = 500 μg/m3. Pulse wave velocity (PWV), central augmentation index (AIx), and central pulse pressure (CPP) were measured before and at three time points after each treatment (0, 3, and 24 h). Linear mixed models were used to assess differences in the outcomes for each cookstove treatment compared to control. PWV and CPP were marginally higher 24 h after all cookstove treatments compared to control. For example, PWV was 0.15 m/s higher (95% confidence interval: -0.02, 0.31) and CPP was 0.6 mmHg higher (95% confidence interval: -0.8, 2.1) 24 h after the three stone fire treatment compared to control. The magnitude of the differences compared to control was similar across all cookstove treatments. PWV and CPP had no consistent trends at the other post-treatment time points (0 and 3 h). No consistent trends were observed for AIx at any post-treatment time point. Our findings suggest higher levels of PWV and CPP within 24 h after 2-h controlled treatments of pollution from five different cookstove technologies. The similar magnitude of the differences following each cookstove treatment compared to control may indicate that acute exposures from even the cleanest cookstove technologies can adversely impact these subclinical markers of cardiovascular health, although differences were small and may not be clinically meaningful.
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Affiliation(s)
- Ethan S Walker
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, CO, USA.
| | - Kristen M Fedak
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, CO, USA.
| | - Nicholas Good
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, CO, USA.
| | - John Balmes
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA.
| | - Robert D Brook
- Division of Cardiovascular Medicine, University of Michigan Medical School, Ann Arbor, MI, USA.
| | - Maggie L Clark
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, CO, USA.
| | - Tom Cole-Hunter
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, CO, USA.
| | - Frank Dinenno
- Department of Health and Exercise Science, Colorado State University, Fort Collins, CO, USA.
| | - Robert B Devlin
- Environmental Public Health Division, United States Environmental Protection Agency, Research Triangle Park, NC, USA.
| | - Christian L'Orange
- Department of Mechanical Engineering, Colorado State University, Fort Collins, CO, USA.
| | | | - John Mehaffy
- Department of Mechanical Engineering, Colorado State University, Fort Collins, CO, USA.
| | - Rhiannon Shelton
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, CO, USA.
| | - Ander Wilson
- Department of Statistics, Colorado State University, Fort Collins, CO, USA.
| | - John Volckens
- Department of Mechanical Engineering, Colorado State University, Fort Collins, CO, USA.
| | - Jennifer L Peel
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, CO, USA.
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Hill LD, Pillarisetti A, Delapena S, Garland C, Pennise D, Pelletreau A, Koetting P, Motmans T, Vongnakhone K, Khammavong C, Boatman MR, Balmes J, Hubbard A, Smith KR. Machine-learned modeling of PM 2.5 exposures in rural Lao PDR. Sci Total Environ 2019; 676:811-822. [PMID: 31071563 DOI: 10.1016/j.scitotenv.2019.04.258] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 03/30/2019] [Accepted: 04/17/2019] [Indexed: 05/05/2023]
Abstract
This study presents a machine-learning-enhanced method of modeling PM2.5 personal exposures in a data-scarce, rural, solid fuel use context. Data collected during a cookstove (Africa Clean Energy (ACE)-1 solar-battery-powered stove) intervention program in rural Lao PDR are presented and leveraged to explore advanced techniques for predicting personal exposures to particulate matter with aerodynamic diameter smaller than 2.5 μm (PM2.5). Mean 48-h PM2.5 exposure concentrations for female cooks were measured for the pre- and post-intervention periods (the "Before" and "After" periods, respectively) as 123 μg/m3 and 81 μg/m3. Mean 48-h PM2.5 kitchen air pollution ("KAP") concentrations were measured at 462 μg/m3 Before and 124 μg/m3 After. Application of machine learning and ensemble modeling demonstrated cross-validated personal exposure predictions that were modest at the individual level but reasonably strong at the group level, with the best models producing an observed vs. predicted r2 between 0.26 and 0.31 (r2 = 0.49 when using a smaller, un-imputed dataset) and mean Before estimates of 119-120 μg/m3 and After estimates of 86-88 μg/m3. This offered improvement over one typical method of predicting exposure - using a kitchen exposure factor (the ratio of exposure to KAP)- which demonstrated an r2 ~ 0.03 and poorly estimated group average values. The results of these analyses highlight areas of methodological improvement for future exposure assessments of household air pollution and provide evidence for researchers to explore the advantages of further incorporating machine learning methods into similar research across wider geographic and cultural contexts.
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Affiliation(s)
- L D Hill
- Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley, 2121 Berkeley Way #5302, Berkeley, CA 94720, USA.
| | - A Pillarisetti
- Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley, 2121 Berkeley Way #5302, Berkeley, CA 94720, USA
| | - S Delapena
- Berkeley Air Monitoring Group, Inc., 1900 Addison St #350, Berkeley, CA 94704, USA
| | - C Garland
- Berkeley Air Monitoring Group, Inc., 1900 Addison St #350, Berkeley, CA 94704, USA
| | - D Pennise
- Berkeley Air Monitoring Group, Inc., 1900 Addison St #350, Berkeley, CA 94704, USA
| | - A Pelletreau
- Lao Institute for Renewable Energy, Ban Watnak Lao-Thai Friendship Road, Sisattanak District, Vientiane, Lao People's Democratic Republic
| | - P Koetting
- Lao Institute for Renewable Energy, Ban Watnak Lao-Thai Friendship Road, Sisattanak District, Vientiane, Lao People's Democratic Republic
| | - T Motmans
- Lao Institute for Renewable Energy, Ban Watnak Lao-Thai Friendship Road, Sisattanak District, Vientiane, Lao People's Democratic Republic
| | - K Vongnakhone
- Lao Institute for Renewable Energy, Ban Watnak Lao-Thai Friendship Road, Sisattanak District, Vientiane, Lao People's Democratic Republic
| | - C Khammavong
- Lao Institute for Renewable Energy, Ban Watnak Lao-Thai Friendship Road, Sisattanak District, Vientiane, Lao People's Democratic Republic
| | - M R Boatman
- Geo-Sys (Lao) Co., Ltd, 136/9, Hom 7, Sokphaluang Village, Sisattanak District, Vientiane, Lao People's Democratic Republic
| | - J Balmes
- Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley, 2121 Berkeley Way #5302, Berkeley, CA 94720, USA; Department of Medicine, University of California, San Francisco, 505 Parnassus Ave, San Francisco, CA 94143, USA
| | - A Hubbard
- Division of Epidemiology and Biostatistics, School of Public Health, University of California, Berkeley, 2121 Berkeley Way #5302, Berkeley, CA 94720, USA
| | - K R Smith
- Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley, 2121 Berkeley Way #5302, Berkeley, CA 94720, USA
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Fedak KM, Good N, Walker ES, Balmes J, Brook RD, Clark ML, Cole-Hunter T, Devlin R, L'Orange C, Luckasen G, Mehaffy J, Shelton R, Wilson A, Volckens J, Peel JL. Acute Effects on Blood Pressure Following Controlled Exposure to Cookstove Air Pollution in the STOVES Study. J Am Heart Assoc 2019; 8:e012246. [PMID: 31286826 PMCID: PMC6662148 DOI: 10.1161/jaha.119.012246] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Background Exposure to air pollution from solid fuel used in residential cookstoves is considered a leading environmental risk factor for disease globally, but evidence for this relationship is largely extrapolated from literature on smoking, secondhand smoke, and ambient fine particulate matter (PM2.5). Methods and Results We conducted a controlled human‐exposure study (STOVES [the Subclinical Tests on Volunteers Exposed to Smoke] Study) to investigate acute responses in blood pressure following exposure to air pollution emissions from cookstove technologies. Forty‐eight healthy adults received 2‐hour exposures to 5 cookstove treatments (three stone fire, rocket elbow, fan rocket elbow, gasifier, and liquefied petroleum gas), spanning PM2.5 concentrations from 10 to 500 μg/m3, and a filtered air control (0 μg/m3). Thirty minutes after exposure, systolic pressure was lower for the three stone fire treatment (500 μg/m3PM2.5) compared with the control (−2.3 mm Hg; 95% CI, −4.5 to −0.1) and suggestively lower for the gasifier (35 μg/m3PM2.5; −1.8 mm Hg; 95% CI, −4.0 to 0.4). No differences were observed at 3 hours after exposure; however, at 24 hours after exposure, mean systolic pressure was 2 to 3 mm Hg higher for all treatments compared with control except for the rocket elbow stove. No differences were observed in diastolic pressure for any time point or treatment. Conclusions Short‐term exposure to air pollution from cookstoves can elicit an increase in systolic pressure within 24 hours. This response occurred across a range of stove types and PM2.5 concentrations, raising concern that even low‐level exposures to cookstove air pollution may pose adverse cardiovascular effects.
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Affiliation(s)
- Kristen M Fedak
- 1 Department of Environmental and Radiological Health Sciences Colorado State University Fort Collins CO
| | - Nicholas Good
- 1 Department of Environmental and Radiological Health Sciences Colorado State University Fort Collins CO
| | - Ethan S Walker
- 1 Department of Environmental and Radiological Health Sciences Colorado State University Fort Collins CO
| | - John Balmes
- 2 Department of Medicine University of California San Francisco San Francisco CA
| | - Robert D Brook
- 3 Division of Cardiovascular Medicine University of Michigan Medical School Ann Arbor MI
| | - Maggie L Clark
- 1 Department of Environmental and Radiological Health Sciences Colorado State University Fort Collins CO
| | - Tom Cole-Hunter
- 1 Department of Environmental and Radiological Health Sciences Colorado State University Fort Collins CO.,4 Centre for Air Pollution, Energy, and Health Research Queensland University of Technology Brisbane Australia
| | - Robert Devlin
- 5 Environmental Public Health Division United States Environmental Protection Agency Chapel Hill NC
| | - Christian L'Orange
- 6 Department of Mechanical Engineering Colorado State University Fort Collins CO
| | | | - John Mehaffy
- 6 Department of Mechanical Engineering Colorado State University Fort Collins CO
| | - Rhiannon Shelton
- 1 Department of Environmental and Radiological Health Sciences Colorado State University Fort Collins CO
| | - Ander Wilson
- 8 Department of Statistics Colorado State University Fort Collins CO
| | - John Volckens
- 6 Department of Mechanical Engineering Colorado State University Fort Collins CO
| | - Jennifer L Peel
- 1 Department of Environmental and Radiological Health Sciences Colorado State University Fort Collins CO
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English P, Balmes J. Associations between Ozone and Fine Particulate Matter and Respiratory Illness Found to Vary between Children and Adults. Implications for U.S. Air Quality Policy. Am J Respir Crit Care Med 2019; 199:817-819. [PMID: 30485120 PMCID: PMC6444659 DOI: 10.1164/rccm.201811-2106ed] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Affiliation(s)
- Paul English
- 1 California Department of Public Health Richmond, California and
| | - John Balmes
- 2 University of California, San Francisco San Francisco, California
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Payne-Sturges DC, Marty MA, Perera F, Miller MD, Swanson M, Ellickson K, Cory-Slechta DA, Ritz B, Balmes J, Anderko L, Talbott EO, Gould R, Hertz-Picciotto I. Healthy Air, Healthy Brains: Advancing Air Pollution Policy to Protect Children's Health. Am J Public Health 2019; 109:550-554. [PMID: 30789769 PMCID: PMC6417586 DOI: 10.2105/ajph.2018.304902] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/24/2018] [Indexed: 11/04/2022]
Abstract
Evidence is growing on the adverse neurodevelopmental effects of exposure to combustion-related air pollution. Project TENDR (Targeting Environmental Neurodevelopmental Risks), a unique collaboration of leading scientists, health professionals, and children's and environmental health advocates, has identified combustion-related air pollutants as critical targets for action to protect healthy brain development. We present policy recommendations for maintaining and strengthening federal environmental health protections, advancing state and local actions, and supporting scientific research to inform effective strategies for reducing children's exposures to combustion-related air pollution. Such actions not only would improve children's neurological development but also would have the important co-benefit of climate change mitigation and further improvements in other health conditions.
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Affiliation(s)
- Devon C Payne-Sturges
- Devon C. Payne-Sturges is with the Maryland Institute for Applied Environmental Health, University of Maryland School of Public Health, College Park. Melanie A. Marty is with the Department of Environmental Toxicology, University of California, Davis. Frederica Perera is with the Columbia Center for Children's Environmental Health, Columbia University, New York, NY. Mark D. Miller and John Balmes are with the Division of Occupational Environmental Medicine, University of California, San Francisco. Maureen Swanson is with the Learning Disabilities Association of America, Pittsburgh, PA. Kristie Ellickson is with the Minnesota State Pollution Control Agency, Saint Paul. Deborah A. Cory-Slechta is with the University of Rochester Medical Center, Rochester, NY. Beate Ritz is with the Fielding School of Public Health, University of California, Los Angeles. Laura Anderko is with the School of Nursing and Health Studies, Georgetown University, Washington, DC. Evelyn O. Talbott is with the School of Public Health, University of Pittsburgh, Pittsburgh. Robert Gould is with the School of Medicine, University of California, San Francisco. Irva Hertz-Picciotto is with the Department of Public Health Sciences, School of Medicine; the MIND Institute; and the Children's Center for Environmental Health, University of California, Davis
| | - Melanie A Marty
- Devon C. Payne-Sturges is with the Maryland Institute for Applied Environmental Health, University of Maryland School of Public Health, College Park. Melanie A. Marty is with the Department of Environmental Toxicology, University of California, Davis. Frederica Perera is with the Columbia Center for Children's Environmental Health, Columbia University, New York, NY. Mark D. Miller and John Balmes are with the Division of Occupational Environmental Medicine, University of California, San Francisco. Maureen Swanson is with the Learning Disabilities Association of America, Pittsburgh, PA. Kristie Ellickson is with the Minnesota State Pollution Control Agency, Saint Paul. Deborah A. Cory-Slechta is with the University of Rochester Medical Center, Rochester, NY. Beate Ritz is with the Fielding School of Public Health, University of California, Los Angeles. Laura Anderko is with the School of Nursing and Health Studies, Georgetown University, Washington, DC. Evelyn O. Talbott is with the School of Public Health, University of Pittsburgh, Pittsburgh. Robert Gould is with the School of Medicine, University of California, San Francisco. Irva Hertz-Picciotto is with the Department of Public Health Sciences, School of Medicine; the MIND Institute; and the Children's Center for Environmental Health, University of California, Davis
| | - Frederica Perera
- Devon C. Payne-Sturges is with the Maryland Institute for Applied Environmental Health, University of Maryland School of Public Health, College Park. Melanie A. Marty is with the Department of Environmental Toxicology, University of California, Davis. Frederica Perera is with the Columbia Center for Children's Environmental Health, Columbia University, New York, NY. Mark D. Miller and John Balmes are with the Division of Occupational Environmental Medicine, University of California, San Francisco. Maureen Swanson is with the Learning Disabilities Association of America, Pittsburgh, PA. Kristie Ellickson is with the Minnesota State Pollution Control Agency, Saint Paul. Deborah A. Cory-Slechta is with the University of Rochester Medical Center, Rochester, NY. Beate Ritz is with the Fielding School of Public Health, University of California, Los Angeles. Laura Anderko is with the School of Nursing and Health Studies, Georgetown University, Washington, DC. Evelyn O. Talbott is with the School of Public Health, University of Pittsburgh, Pittsburgh. Robert Gould is with the School of Medicine, University of California, San Francisco. Irva Hertz-Picciotto is with the Department of Public Health Sciences, School of Medicine; the MIND Institute; and the Children's Center for Environmental Health, University of California, Davis
| | - Mark D Miller
- Devon C. Payne-Sturges is with the Maryland Institute for Applied Environmental Health, University of Maryland School of Public Health, College Park. Melanie A. Marty is with the Department of Environmental Toxicology, University of California, Davis. Frederica Perera is with the Columbia Center for Children's Environmental Health, Columbia University, New York, NY. Mark D. Miller and John Balmes are with the Division of Occupational Environmental Medicine, University of California, San Francisco. Maureen Swanson is with the Learning Disabilities Association of America, Pittsburgh, PA. Kristie Ellickson is with the Minnesota State Pollution Control Agency, Saint Paul. Deborah A. Cory-Slechta is with the University of Rochester Medical Center, Rochester, NY. Beate Ritz is with the Fielding School of Public Health, University of California, Los Angeles. Laura Anderko is with the School of Nursing and Health Studies, Georgetown University, Washington, DC. Evelyn O. Talbott is with the School of Public Health, University of Pittsburgh, Pittsburgh. Robert Gould is with the School of Medicine, University of California, San Francisco. Irva Hertz-Picciotto is with the Department of Public Health Sciences, School of Medicine; the MIND Institute; and the Children's Center for Environmental Health, University of California, Davis
| | - Maureen Swanson
- Devon C. Payne-Sturges is with the Maryland Institute for Applied Environmental Health, University of Maryland School of Public Health, College Park. Melanie A. Marty is with the Department of Environmental Toxicology, University of California, Davis. Frederica Perera is with the Columbia Center for Children's Environmental Health, Columbia University, New York, NY. Mark D. Miller and John Balmes are with the Division of Occupational Environmental Medicine, University of California, San Francisco. Maureen Swanson is with the Learning Disabilities Association of America, Pittsburgh, PA. Kristie Ellickson is with the Minnesota State Pollution Control Agency, Saint Paul. Deborah A. Cory-Slechta is with the University of Rochester Medical Center, Rochester, NY. Beate Ritz is with the Fielding School of Public Health, University of California, Los Angeles. Laura Anderko is with the School of Nursing and Health Studies, Georgetown University, Washington, DC. Evelyn O. Talbott is with the School of Public Health, University of Pittsburgh, Pittsburgh. Robert Gould is with the School of Medicine, University of California, San Francisco. Irva Hertz-Picciotto is with the Department of Public Health Sciences, School of Medicine; the MIND Institute; and the Children's Center for Environmental Health, University of California, Davis
| | - Kristie Ellickson
- Devon C. Payne-Sturges is with the Maryland Institute for Applied Environmental Health, University of Maryland School of Public Health, College Park. Melanie A. Marty is with the Department of Environmental Toxicology, University of California, Davis. Frederica Perera is with the Columbia Center for Children's Environmental Health, Columbia University, New York, NY. Mark D. Miller and John Balmes are with the Division of Occupational Environmental Medicine, University of California, San Francisco. Maureen Swanson is with the Learning Disabilities Association of America, Pittsburgh, PA. Kristie Ellickson is with the Minnesota State Pollution Control Agency, Saint Paul. Deborah A. Cory-Slechta is with the University of Rochester Medical Center, Rochester, NY. Beate Ritz is with the Fielding School of Public Health, University of California, Los Angeles. Laura Anderko is with the School of Nursing and Health Studies, Georgetown University, Washington, DC. Evelyn O. Talbott is with the School of Public Health, University of Pittsburgh, Pittsburgh. Robert Gould is with the School of Medicine, University of California, San Francisco. Irva Hertz-Picciotto is with the Department of Public Health Sciences, School of Medicine; the MIND Institute; and the Children's Center for Environmental Health, University of California, Davis
| | - Deborah A Cory-Slechta
- Devon C. Payne-Sturges is with the Maryland Institute for Applied Environmental Health, University of Maryland School of Public Health, College Park. Melanie A. Marty is with the Department of Environmental Toxicology, University of California, Davis. Frederica Perera is with the Columbia Center for Children's Environmental Health, Columbia University, New York, NY. Mark D. Miller and John Balmes are with the Division of Occupational Environmental Medicine, University of California, San Francisco. Maureen Swanson is with the Learning Disabilities Association of America, Pittsburgh, PA. Kristie Ellickson is with the Minnesota State Pollution Control Agency, Saint Paul. Deborah A. Cory-Slechta is with the University of Rochester Medical Center, Rochester, NY. Beate Ritz is with the Fielding School of Public Health, University of California, Los Angeles. Laura Anderko is with the School of Nursing and Health Studies, Georgetown University, Washington, DC. Evelyn O. Talbott is with the School of Public Health, University of Pittsburgh, Pittsburgh. Robert Gould is with the School of Medicine, University of California, San Francisco. Irva Hertz-Picciotto is with the Department of Public Health Sciences, School of Medicine; the MIND Institute; and the Children's Center for Environmental Health, University of California, Davis
| | - Beate Ritz
- Devon C. Payne-Sturges is with the Maryland Institute for Applied Environmental Health, University of Maryland School of Public Health, College Park. Melanie A. Marty is with the Department of Environmental Toxicology, University of California, Davis. Frederica Perera is with the Columbia Center for Children's Environmental Health, Columbia University, New York, NY. Mark D. Miller and John Balmes are with the Division of Occupational Environmental Medicine, University of California, San Francisco. Maureen Swanson is with the Learning Disabilities Association of America, Pittsburgh, PA. Kristie Ellickson is with the Minnesota State Pollution Control Agency, Saint Paul. Deborah A. Cory-Slechta is with the University of Rochester Medical Center, Rochester, NY. Beate Ritz is with the Fielding School of Public Health, University of California, Los Angeles. Laura Anderko is with the School of Nursing and Health Studies, Georgetown University, Washington, DC. Evelyn O. Talbott is with the School of Public Health, University of Pittsburgh, Pittsburgh. Robert Gould is with the School of Medicine, University of California, San Francisco. Irva Hertz-Picciotto is with the Department of Public Health Sciences, School of Medicine; the MIND Institute; and the Children's Center for Environmental Health, University of California, Davis
| | - John Balmes
- Devon C. Payne-Sturges is with the Maryland Institute for Applied Environmental Health, University of Maryland School of Public Health, College Park. Melanie A. Marty is with the Department of Environmental Toxicology, University of California, Davis. Frederica Perera is with the Columbia Center for Children's Environmental Health, Columbia University, New York, NY. Mark D. Miller and John Balmes are with the Division of Occupational Environmental Medicine, University of California, San Francisco. Maureen Swanson is with the Learning Disabilities Association of America, Pittsburgh, PA. Kristie Ellickson is with the Minnesota State Pollution Control Agency, Saint Paul. Deborah A. Cory-Slechta is with the University of Rochester Medical Center, Rochester, NY. Beate Ritz is with the Fielding School of Public Health, University of California, Los Angeles. Laura Anderko is with the School of Nursing and Health Studies, Georgetown University, Washington, DC. Evelyn O. Talbott is with the School of Public Health, University of Pittsburgh, Pittsburgh. Robert Gould is with the School of Medicine, University of California, San Francisco. Irva Hertz-Picciotto is with the Department of Public Health Sciences, School of Medicine; the MIND Institute; and the Children's Center for Environmental Health, University of California, Davis
| | - Laura Anderko
- Devon C. Payne-Sturges is with the Maryland Institute for Applied Environmental Health, University of Maryland School of Public Health, College Park. Melanie A. Marty is with the Department of Environmental Toxicology, University of California, Davis. Frederica Perera is with the Columbia Center for Children's Environmental Health, Columbia University, New York, NY. Mark D. Miller and John Balmes are with the Division of Occupational Environmental Medicine, University of California, San Francisco. Maureen Swanson is with the Learning Disabilities Association of America, Pittsburgh, PA. Kristie Ellickson is with the Minnesota State Pollution Control Agency, Saint Paul. Deborah A. Cory-Slechta is with the University of Rochester Medical Center, Rochester, NY. Beate Ritz is with the Fielding School of Public Health, University of California, Los Angeles. Laura Anderko is with the School of Nursing and Health Studies, Georgetown University, Washington, DC. Evelyn O. Talbott is with the School of Public Health, University of Pittsburgh, Pittsburgh. Robert Gould is with the School of Medicine, University of California, San Francisco. Irva Hertz-Picciotto is with the Department of Public Health Sciences, School of Medicine; the MIND Institute; and the Children's Center for Environmental Health, University of California, Davis
| | - Evelyn O Talbott
- Devon C. Payne-Sturges is with the Maryland Institute for Applied Environmental Health, University of Maryland School of Public Health, College Park. Melanie A. Marty is with the Department of Environmental Toxicology, University of California, Davis. Frederica Perera is with the Columbia Center for Children's Environmental Health, Columbia University, New York, NY. Mark D. Miller and John Balmes are with the Division of Occupational Environmental Medicine, University of California, San Francisco. Maureen Swanson is with the Learning Disabilities Association of America, Pittsburgh, PA. Kristie Ellickson is with the Minnesota State Pollution Control Agency, Saint Paul. Deborah A. Cory-Slechta is with the University of Rochester Medical Center, Rochester, NY. Beate Ritz is with the Fielding School of Public Health, University of California, Los Angeles. Laura Anderko is with the School of Nursing and Health Studies, Georgetown University, Washington, DC. Evelyn O. Talbott is with the School of Public Health, University of Pittsburgh, Pittsburgh. Robert Gould is with the School of Medicine, University of California, San Francisco. Irva Hertz-Picciotto is with the Department of Public Health Sciences, School of Medicine; the MIND Institute; and the Children's Center for Environmental Health, University of California, Davis
| | - Robert Gould
- Devon C. Payne-Sturges is with the Maryland Institute for Applied Environmental Health, University of Maryland School of Public Health, College Park. Melanie A. Marty is with the Department of Environmental Toxicology, University of California, Davis. Frederica Perera is with the Columbia Center for Children's Environmental Health, Columbia University, New York, NY. Mark D. Miller and John Balmes are with the Division of Occupational Environmental Medicine, University of California, San Francisco. Maureen Swanson is with the Learning Disabilities Association of America, Pittsburgh, PA. Kristie Ellickson is with the Minnesota State Pollution Control Agency, Saint Paul. Deborah A. Cory-Slechta is with the University of Rochester Medical Center, Rochester, NY. Beate Ritz is with the Fielding School of Public Health, University of California, Los Angeles. Laura Anderko is with the School of Nursing and Health Studies, Georgetown University, Washington, DC. Evelyn O. Talbott is with the School of Public Health, University of Pittsburgh, Pittsburgh. Robert Gould is with the School of Medicine, University of California, San Francisco. Irva Hertz-Picciotto is with the Department of Public Health Sciences, School of Medicine; the MIND Institute; and the Children's Center for Environmental Health, University of California, Davis
| | - Irva Hertz-Picciotto
- Devon C. Payne-Sturges is with the Maryland Institute for Applied Environmental Health, University of Maryland School of Public Health, College Park. Melanie A. Marty is with the Department of Environmental Toxicology, University of California, Davis. Frederica Perera is with the Columbia Center for Children's Environmental Health, Columbia University, New York, NY. Mark D. Miller and John Balmes are with the Division of Occupational Environmental Medicine, University of California, San Francisco. Maureen Swanson is with the Learning Disabilities Association of America, Pittsburgh, PA. Kristie Ellickson is with the Minnesota State Pollution Control Agency, Saint Paul. Deborah A. Cory-Slechta is with the University of Rochester Medical Center, Rochester, NY. Beate Ritz is with the Fielding School of Public Health, University of California, Los Angeles. Laura Anderko is with the School of Nursing and Health Studies, Georgetown University, Washington, DC. Evelyn O. Talbott is with the School of Public Health, University of Pittsburgh, Pittsburgh. Robert Gould is with the School of Medicine, University of California, San Francisco. Irva Hertz-Picciotto is with the Department of Public Health Sciences, School of Medicine; the MIND Institute; and the Children's Center for Environmental Health, University of California, Davis
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Rhee J, Dominici F, Zanobetti A, Schwartz J, Wang Y, Di Q, Balmes J, Christiani DC. Impact of Long-Term Exposures to Ambient PM 2.5 and Ozone on ARDS Risk for Older Adults in the United States. Chest 2019; 156:71-79. [PMID: 30926395 DOI: 10.1016/j.chest.2019.03.017] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 02/27/2019] [Accepted: 03/01/2019] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Chronic exposures to particulate matter with an aerodynamic diameter < 2.5 μm (PM2.5) and ozone pollution can affect respiratory function. ARDS, an often lethal respiratory failure, is most common among older adults. However, few epidemiology studies have investigated an association between air pollution and the risk of ARDS. METHODS This observational study was conducted to estimate air pollution exposures at the ZIP code level and hospital admissions with ARDS among US Medicare beneficiaries aged ≥ 65 years from 2000 to 2012. A two-pollutant generalized linear mixed model, adjusting for sex, age, race, median household income, smoking, and weather, was applied. RESULTS There were a total of 1,164,784 hospital admissions with ARDS in the cohort. Increases of 1 µg/m3 in annual average PM2.5 and of 1 parts per billion in annual average ozone were associated with increases in annual hospital admission rates for ARDS of 0.72% (95% CI, 0.62-0.82) and 0.15% (95% CI, 0.08-0.22), respectively. In low-pollution regions (annual average PM2.5 level < 12 µg/m3 and annual average ozone level < 45 parts per billion), the same annual increase in PM2.5 and ozone were associated with increases in annual hospital admission rates for ARDS of 1.50% (95% CI, 1.27-1.72) and 0.27% (95% CI, 0.16-0.38). CONCLUSIONS Long-term exposures to PM2.5 and ozone were associated with increased risk of ARDS among older adults in the United States, including exposures below current annual US National Ambient Air Quality Standards.
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Affiliation(s)
- Jongeun Rhee
- Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA
| | - Francesca Dominici
- Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA
| | | | - Joel Schwartz
- Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA
| | - Yun Wang
- Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA
| | - Qian Di
- Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA
| | - John Balmes
- Department of Medicine, University of California San Francisco, San Francisco, CA; School of Public Health, University of California Berkeley, Berkeley, CA
| | - David C Christiani
- Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA.
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Tagle M, Pillarisetti A, Hernandez MT, Troncoso K, Soares A, Torres R, Galeano A, Oyola P, Balmes J, Smith KR. Monitoring and modeling of household air quality related to use of different Cookfuels in Paraguay. Indoor Air 2019; 29:252-262. [PMID: 30339298 PMCID: PMC6849814 DOI: 10.1111/ina.12513] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 08/16/2018] [Accepted: 10/12/2018] [Indexed: 06/02/2023]
Abstract
In Paraguay, 49% of the population depends on biomass (wood and charcoal) for cooking. Residential biomass burning is a major source of fine particulate matter (PM2.5 ) and carbon monoxide (CO) in and around the household environment. In July 2016, cross-sectional household air pollution sampling was conducted in 80 households in rural Paraguay. Time-integrated samples (24 hours) of PM2.5 and continuous CO concentrations were measured in kitchens that used wood, charcoal, liquefied petroleum gas (LPG), or electricity to cook. Qualitative and quantitative household-level variables were captured using questionnaires. The average PM2.5 concentration (μg/m3 ) was higher in kitchens that burned wood (741.7 ± 546.4) and charcoal (107.0 ± 68.6) than in kitchens where LPG (52.3 ± 18.9) or electricity (52.0 ± 14.8) was used. Likewise, the average CO concentration (ppm) was higher in kitchens that used wood (19.4 ± 12.6) and charcoal (7.6 ± 6.5) than in those that used LPG (0.5 ± 0.6) or electricity (0.4 ± 0.6). Multivariable linear regression was conducted to generate predictive models for indoor PM2.5 and CO concentrations (predicted R2 = 0.837 and 0.822, respectively). This study provides baseline indoor air quality data for Paraguay and presents a multivariate statistical approach that could be used in future research and intervention programs.
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Affiliation(s)
- Matias Tagle
- Environmental Health SciencesSchool of Public HealthUniversity of California at BerkeleyBerkeleyCalifornia
- Centro Mario Molina ChileProvidencia, SantiagoChile
| | - Ajay Pillarisetti
- Environmental Health SciencesSchool of Public HealthUniversity of California at BerkeleyBerkeleyCalifornia
| | - Maria Teresa Hernandez
- Environmental Health SciencesSchool of Public HealthUniversity of California at BerkeleyBerkeleyCalifornia
| | - Karin Troncoso
- Pan American Health OrganizationWashingtonDistrict of Columbia
| | - Agnes Soares
- Pan American Health OrganizationWashingtonDistrict of Columbia
| | - Ricardo Torres
- Pan American Health OrganizationWashingtonDistrict of Columbia
| | - Aida Galeano
- Dirección General de Salud AmbientalSan LorenzoParaguay
| | - Pedro Oyola
- Centro Mario Molina ChileProvidencia, SantiagoChile
| | - John Balmes
- Environmental Health SciencesSchool of Public HealthUniversity of California at BerkeleyBerkeleyCalifornia
- School of MedicineUniversity of CaliforniaSan FranciscoCalifornia
| | - Kirk R. Smith
- Environmental Health SciencesSchool of Public HealthUniversity of California at BerkeleyBerkeleyCalifornia
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Nightingale R, Lesosky M, Flitz G, Rylance SJ, Meghji J, Burney P, Balmes J, Mortimer K. Noncommunicable Respiratory Disease and Air Pollution Exposure in Malawi (CAPS). A Cross-Sectional Study. Am J Respir Crit Care Med 2019; 199:613-621. [PMID: 30141966 PMCID: PMC6396863 DOI: 10.1164/rccm.201805-0936oc] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Accepted: 08/22/2018] [Indexed: 11/16/2022] Open
Abstract
RATIONALE Noncommunicable respiratory diseases and exposure to air pollution are thought to be important contributors to morbidity and mortality in sub-Saharan African adults. OBJECTIVES We set out to explore the prevalence and determinants of noncommunicable respiratory disease among adults living in Chikhwawa District, Malawi. METHODS We performed a cross-sectional study among adults in communities participating in a randomized controlled trial of a cleaner-burning biomass-fueled cookstove intervention (CAPS [Cooking and Pneumonia Study]) in rural Malawi. We assessed chronic respiratory symptoms, spirometric abnormalities, and personal exposure to air pollution (particulate matter <2.5 μm in aerodynamic diameter [PM2.5] and carbon monoxide [CO]). Weighted prevalence estimates were calculated; multivariable and intention-to-treat analyses were done. MEASUREMENTS AND MAIN RESULTS One thousand four hundred eighty-one participants (mean [SD] age, 43.8 [17.8] yr; 57% female) were recruited. The prevalence of chronic respiratory symptoms, spirometric obstruction, and restriction were 13.6% (95% confidence interval [CI], 11.9-15.4), 8.7% (95% CI, 7.0-10.7), and 34.8% (95% CI, 31.7-38.0), respectively. Median 48-hour personal PM2.5 and CO exposures were 71.0 μg/m3 (interquartile range [IQR], 44.6-119.2) and 1.23 ppm (IQR, 0.79-1.93), respectively. Chronic respiratory symptoms were associated with current/ex-smoking (odds ratio [OR], 1.59; 95% CI, 1.05-2.39), previous tuberculosis (OR, 2.50; 95% CI, 1.04-15.58), and CO exposure (OR, 1.46; 95% CI, 1.04-2.05). Exposure to PM2.5 was not associated with any demographic, clinical, or spirometric characteristics. There was no effect of the CAPS intervention on any of the secondary trial outcomes. CONCLUSIONS The burden of chronic respiratory symptoms, abnormal spirometry, and air pollution exposures in adults in rural Malawi is of considerable potential public health importance. We found little evidence that air pollution exposures were associated with chronic respiratory symptoms or spirometric abnormalities and no evidence that the CAPS intervention had effects on the secondary trial outcomes. More effective prevention and control strategies for noncommunicable respiratory disease in sub-Saharan Africa are needed. Clinical trial registered with www.isrctn.com (ISRCTN 59448623).
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Affiliation(s)
- Rebecca Nightingale
- Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- Malawi Liverpool Wellcome Trust Programme, Blantyre, Malawi
| | - Maia Lesosky
- Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | | | - Sarah J. Rylance
- Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- Malawi Liverpool Wellcome Trust Programme, Blantyre, Malawi
| | - Jamilah Meghji
- Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- Malawi Liverpool Wellcome Trust Programme, Blantyre, Malawi
| | - Peter Burney
- National Heart and Lung Institute, Imperial College, London, United Kingdom; and
| | - John Balmes
- University of California, Berkeley, California
- University of California, San Francisco, San Francisco, California
| | - Kevin Mortimer
- Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- Malawi Liverpool Wellcome Trust Programme, Blantyre, Malawi
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Padula AM, Yang W, Lurmann FW, Balmes J, Hammond SK, Shaw GM. Prenatal exposure to air pollution, maternal diabetes and preterm birth. Environ Res 2019; 170:160-167. [PMID: 30579990 PMCID: PMC6373725 DOI: 10.1016/j.envres.2018.12.031] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [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: 10/23/2018] [Revised: 12/03/2018] [Accepted: 12/14/2018] [Indexed: 05/21/2023]
Abstract
Prenatal exposure to ambient air pollution has been associated with preterm birth in several studies. Associations between air pollution and gestational or pre-existing diabetes have been hypothesized but are not well established. We examined the association between air pollution exposure in pregnancy and gestational diabetes and whether the association between air pollution and preterm birth is modified by diabetes (gestational or pre-existing) in a highly polluted area of California. Birth certificates and hospital discharge data from all singleton births from 2000 to 2006 to women living in four counties in the San Joaquin Valley of California were linked to criteria air pollution and traffic density measurements at the geocoded maternal residence. Air pollutants were dichotomized at the highest quartile and compared to the lower three quartiles. Logistic regression models were adjusted for maternal race-ethnicity, age, education, payment of birth expenses, and prenatal care. There were consistent inverse associations between exposure to air pollution during the first two trimesters and gestational diabetes (statistically significant odds ratios (OR) less than 1). When stratified by any diabetes (gestational or pre-existing), associations between air pollution exposure during pregnancy and categories of preterm birth (20-27, 28-31, 32-33, 34-36 weeks) were generally similar with few exceptions of exposures to carbon monoxide (CO) and particulate matter < 2.5 µm (PM2.5). Those with diabetes and exposure higher levels of CO (in first trimester or entire pregnancy) or PM2.5 (in first trimester) had higher risk of extremely preterm birth (20-27 weeks) compared with those without diabetes. The associations between traffic-related air pollution and gestational diabetes were in the unexpected ("protective") direction. Among those with any diabetes, associations were stronger between CO and PM2.5 and extremely preterm birth.
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Affiliation(s)
- Amy M Padula
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, San Francisco, CA, USA.
| | - Wei Yang
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA, USA
| | | | - John Balmes
- Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley, Berkeley, CA, USA; Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - S Katharine Hammond
- Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley, Berkeley, CA, USA
| | - Gary M Shaw
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA, USA
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Berger K, Eskenazi B, Balmes J, Kogut K, Holland N, Calafat AM, Harley KG. Prenatal high molecular weight phthalates and bisphenol A, and childhood respiratory and allergic outcomes. Pediatr Allergy Immunol 2019; 30:36-46. [PMID: 30338578 PMCID: PMC6436539 DOI: 10.1111/pai.12992] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Revised: 09/12/2018] [Accepted: 10/02/2018] [Indexed: 02/05/2023]
Abstract
BACKGROUND The prevalence of asthma and allergy is increasing in US children. In utero exposure to chemicals used in personal care products and plastics may contribute to increase in these diseases. METHODS We quantified urinary concentrations of eight phthalate metabolites and bisphenol A in mothers twice during pregnancy in 1999-2000 in Salinas, California. We assessed probable asthma, aeroallergies, eczema, and spirometry in their children at age 7, and measured T helper 1 and T helper 2 cells in blood at ages 2, 5, and 7 (N = 392). We employed Bayesian model averaging to select confounders from additional biomarkers measured in this population and controlled for them in logistic and linear regressions. RESULTS Monocarboxyisooctyl phthalate was associated with increased odds for probable asthma (odds ratio: 1.54, 95% CI: 1.12, 2.12), and with lower forced expiratory volume in one second (β: -0.09 L, 95% CI: -0.15, -0.03) and forced expiratory flow from 25% to 75% of forced vital capacity (β: -7.06 L/s, 95% CI: -11.04, -2.90). Several other associations were attenuated in final models that controlled for additional biomarkers. CONCLUSION Monocarboxyisooctyl phthalate was associated with lower respiratory health after controlling for related chemical exposure, which suggests that confounding by multiple chemical exposures should be considered in future research.
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Affiliation(s)
- Kimberly Berger
- Center for Environmental Research and Children's Health (CERCH), School of Public Health, University of California, Berkeley, Berkeley, California
| | - Brenda Eskenazi
- Center for Environmental Research and Children's Health (CERCH), School of Public Health, University of California, Berkeley, Berkeley, California
| | - John Balmes
- Center for Environmental Research and Children's Health (CERCH), School of Public Health, University of California, Berkeley, Berkeley, California
| | - Katie Kogut
- Center for Environmental Research and Children's Health (CERCH), School of Public Health, University of California, Berkeley, Berkeley, California
| | - Nina Holland
- Center for Environmental Research and Children's Health (CERCH), School of Public Health, University of California, Berkeley, Berkeley, California
| | - Antonia M Calafat
- Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Kim G Harley
- Center for Environmental Research and Children's Health (CERCH), School of Public Health, University of California, Berkeley, Berkeley, California
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Jamil S, Carlos WG, Leard L, Wang A, Santhosh L, Balmes J, Seam N, Dela Cruz CS. Wildfires Disaster Guidance: Tips for Staying Healthy during Wildfires. Am J Respir Crit Care Med 2019; 199:P3-P4. [PMID: 30644780 DOI: 10.1164/rccm.1992p3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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43
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Berger K, Eskenazi B, Balmes J, Holland N, Calafat AM, Harley KG. Associations between prenatal maternal urinary concentrations of personal care product chemical biomarkers and childhood respiratory and allergic outcomes in the CHAMACOS study. Environ Int 2018; 121:538-549. [PMID: 30293015 PMCID: PMC6239199 DOI: 10.1016/j.envint.2018.09.027] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [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: 06/15/2018] [Revised: 09/13/2018] [Accepted: 09/16/2018] [Indexed: 05/19/2023]
Abstract
BACKGROUND Personal care product chemicals may be contributing to risk for asthma and other atopic illnesses. The existing literature is conflicting, and many studies do not control for multiple chemical exposures. METHODS We quantified concentrations of three phthalate metabolites, three parabens, and four other phenols in urine collected twice during pregnancy from 392 women. We measured T helper 1 (Th1) and T helper 2 (Th2) cells in their children's blood at ages two, five, and seven, and assessed probable asthma, aeroallergies, eczema, and lung function at age seven. We conducted linear and logistic regressions, controlling for additional biomarkers measured in this population as selected by Bayesian Model Averaging. RESULTS The majority of comparisons showed null associations. Mono-n-butyl phthalate (MnBP) was associated with higher Th2% (RR: 10.40, 95% CI: 3.37, 17.92), and methyl paraben was associated with lower Th1% (RR: -3.35, 95% CI: -6.58, -0.02) and Th2% at borderline significance (RR: -4.45, 95% CI: -8.77, 0.08). Monoethyl phthalate was associated with lower forced expiratory flow from 25 to 75% of forced vital capacity (FEF25-75%) (RR: -3.22 L/s, 95% CI: -6.02, -0.34). Propyl paraben (OR: 0.86, 95% CI: 0.74, 0.99) was associated with decreased odds of probable asthma. CONCLUSIONS While some biomarkers, particularly those from low molecular weight phthalates, were associated with an atopic cytokine profile and poorer lung function, no biomarkers were associated with a corresponding increase in atopic disease.
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Affiliation(s)
- Kimberly Berger
- Center for Environmental Research and Children's Health (CERCH), School of Public Health, University of California, Berkeley, 1995 University Avenue, Berkeley, CA 94704, USA
| | - Brenda Eskenazi
- Center for Environmental Research and Children's Health (CERCH), School of Public Health, University of California, Berkeley, 1995 University Avenue, Berkeley, CA 94704, USA
| | - John Balmes
- Center for Environmental Research and Children's Health (CERCH), School of Public Health, University of California, Berkeley, 1995 University Avenue, Berkeley, CA 94704, USA
| | - Nina Holland
- Center for Environmental Research and Children's Health (CERCH), School of Public Health, University of California, Berkeley, 1995 University Avenue, Berkeley, CA 94704, USA
| | - Antonia M Calafat
- Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, 4770 Buford Hwy, Atlanta, GA 30341, USA
| | - Kim G Harley
- Center for Environmental Research and Children's Health (CERCH), School of Public Health, University of California, Berkeley, 1995 University Avenue, Berkeley, CA 94704, USA.
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44
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Ortega Hinojosa AM, MacLeod KE, Balmes J, Jerrett M. Influence of school environments on childhood obesity in California. Environ Res 2018; 166:100-107. [PMID: 29883903 DOI: 10.1016/j.envres.2018.04.022] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Revised: 04/19/2018] [Accepted: 04/19/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To conduct a state-wide examination of public schools and the school neighborhood as potential targets for environmental public health tracking to address childhood obesity. METHODS We examined the relationship of social and physical environmental attributes of the school environment (within school and neighborhood) and childhood obesity in California with machine learning (Random Forest) and multilevel methods. We used data compiled from the California Department of Education, the U.S. Geological Survey, ESRI's Business Analyst, the U.S. Census, and other public sources for ecologic level variables for various years and assessed their relative importance to obesity as determined from the statewide Physical Fitness Test 2003 through 2007 for grades 5, 7, and 9 (n = 5,265,265). RESULTS In addition to individual-level race and gender, the following within and school neighborhood variables ranked as the most important model contributors based on the Random Forest analysis and were included in multilevel regressions clustered on the county. Violent crime, English learners, socioeconomic disadvantage, fewer physical education (PE) and fully credentialed teachers, and diversity index were positively associated with obesity while academic performance index, PE participation, mean educational attainment and per capita income were negatively associated with obesity. The most highly ranked built or physical environment variables were distance to the nearest highway and greenness, which were 10th and 11th most important, respectively. CONCLUSIONS Many states in the U.S. do not have school-based surveillance programs that collect body mass index data. System-level determinants of obesity can be important for tracking and intervention. The results of these analyses suggest that the school social environment factors may be especially important. Disadvantaged and low academic performing schools have a higher risk for obesity. Supporting such schools in a targeted way may be an efficient way to intervene and could impact both health and academic outcomes. Some of the more important variables, such as having credentialed teachers and participating in PE, are modifiable risk factors.
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Affiliation(s)
- Alberto M Ortega Hinojosa
- School of Public Health, University of California, Berkeley, Berkeley, CA 94720, United States; IMPAQ International, LLC, Oakland, CA 94612, United States
| | - Kara E MacLeod
- Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA 90095, United States
| | - John Balmes
- School of Public Health, University of California, Berkeley, Berkeley, CA 94720, United States
| | - Michael Jerrett
- School of Public Health, University of California, Berkeley, Berkeley, CA 94720, United States; Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA 90095, United States.
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Havens D, Wang D, Grigg J, Gordon SB, Balmes J, Mortimer K. The Cooking and Pneumonia Study (CAPS) in Malawi: A Cross-Sectional Assessment of Carbon Monoxide Exposure and Carboxyhemoglobin Levels in Children under 5 Years Old. Int J Environ Res Public Health 2018; 15:ijerph15091936. [PMID: 30189674 PMCID: PMC6163876 DOI: 10.3390/ijerph15091936] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 08/22/2018] [Accepted: 08/30/2018] [Indexed: 12/31/2022]
Abstract
Household air pollution is estimated to cause half a million deaths from pneumonia in children worldwide. The Cooking and Pneumonia Study (CAPS) was conducted to determine whether the use of cleaner-burning biomass-fueled cookstoves would reduce household air pollution and thereby the incidence of pneumonia in young children in rural Malawi. Here we report a cross-sectional assessment of carbon monoxide (CO) exposure and carboxyhemoglobin (COHgB) levels at recruitment to CAPS. Mean (SD; range) 48-h CO exposure of 1928 participating children was 0.90 (2.3; 0–49) ppm and mean (SD; range) COHgB level was 5.8% (3.3; 0–20.3). Higher mean CO and COHgB levels were associated with location (Chikhwawa versus Chilumba) (OR 3.55 (1.73–7.26)); (OR 2.77 (1.08–7.08)). Correlation between mean CO and COHgB was poor (Spearman’s ρ = 0.09, p < 0.001). The finding of high COHgB levels in young children in rural Malawi that are at levels at which adverse neurodevelopmental and cognitive effects occur is of concern. Effective approaches for reducing exposure to CO and other constituents of air pollution in rural sub-Saharan African settings are urgently needed.
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Affiliation(s)
- Deborah Havens
- Liverpool School of Tropical Medicine, Liverpool L3 5QA, UK.
| | - Duolao Wang
- Liverpool School of Tropical Medicine, Liverpool L3 5QA, UK.
| | - Jonathan Grigg
- Centre for Genomics and Child Health, Queen Mary University of London, London E1 2AT, UK.
| | | | - John Balmes
- Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley, Berkeley, CA 94720-7360, USA.
- Department of Medicine, University of California, San Francisco, San Francisco, CA 94143-0844, USA.
| | - Kevin Mortimer
- Liverpool School of Tropical Medicine, Liverpool L3 5QA, UK.
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Lawin H, Fanou LA, Kpangon AA, Hinson AV, Balmes J, Wanjiku J, Ale BM, Fayomi B. Comparison of motorcycle taxi driver's respiratory health using an air quality standard for carbon monoxide in ambient air: a pilot survey in Benin. Pan Afr Med J 2018; 30:113. [PMID: 30364347 PMCID: PMC6195239 DOI: 10.11604/pamj.2018.30.113.14975] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Accepted: 05/25/2018] [Indexed: 11/11/2022] Open
Abstract
Introduction Ambient air quality standards are not designed to protect people occupationally exposed to outdoor air pollution on a routine basis. This study aimed to assess the effect of exceeding the US ambient air quality standard for carbon monoxide (CO) on motorcycle taxi drivers respiratory health. Methods A cross-sectional study of 85 current motorcycle taxi drivers with at least 5 years of job tenure in Cotonou (Benin) was conducted. Personal CO was measured with a portable CO data logger for 8 hours per day during working hours. A questionnaire on respiratory symptoms was administered to participants and spirometry was performed. Participants were divided into two groups, those with exposure to CO >9 ppm and ≤9 ppm, according to the US Environmental Protection Agency (EPA) National Ambient Air Quality Standard which is an 8-hour average of 9ppm. 8 and 10 ppm were also used an exposure limit. Analysis was done using these two groups. Results Socio-demographic characteristics were well balanced between the two study groups. The drivers with a CO exposure of more than 9ppm had non-significantly more respiratory symptoms (OR=1.67; 95%CI:0.26,10.74), lower FVC and FEV1 compared to the less exposed group but they have a significant lower PEF (-10%, p=0.02). When we used an exposure limit of 8 or 10 ppm the results were not statistically different. Conclusion Drivers with a CO exposure >9 ppm tend to have more respiratory problems. More research is needed to reinforce this result in order to improve air quality standards to protect workers occupationally exposed to outdoor air pollution.
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Affiliation(s)
- Herve Lawin
- Unit of Teaching and Research in Occupational and Environmental Health, Faculty of Health Sciences, University of Abomey-Calavi, Benin.,EcoHealth Chair, Faculty of Health Sciences, University of Abomey Calavi, Cotonou, Benin
| | - Lucie Ayi Fanou
- Laboratoire de Biochimie et de Biologie Moléculaire, FAST/UAC, Bénin
| | | | - Antoine Vikkey Hinson
- Unit of Teaching and Research in Occupational and Environmental Health, Faculty of Health Sciences, University of Abomey-Calavi, Benin
| | - John Balmes
- Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley, USA
| | | | - Boni Maxime Ale
- Institute of Tropical and Infectious diseases, University of Nairobi, Kenya
| | - Benjamin Fayomi
- Unit of Teaching and Research in Occupational and Environmental Health, Faculty of Health Sciences, University of Abomey-Calavi, Benin.,EcoHealth Chair, Faculty of Health Sciences, University of Abomey Calavi, Cotonou, Benin
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Holm SM, Balmes J, Gillette D, Hartin K, Seto E, Lindeman D, Polanco D, Fong E. Cooking behaviors are related to household particulate matter exposure in children with asthma in the urban East Bay Area of Northern California. PLoS One 2018; 13:e0197199. [PMID: 29874253 PMCID: PMC5991365 DOI: 10.1371/journal.pone.0197199] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2017] [Accepted: 04/27/2018] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Asthma is a common childhood disease that leads to many missed days of school and parents' work. There are multiple environmental contributors to asthma symptoms and understanding the potential factors inside children's homes is crucial. METHODS This is a dual cohort study measuring household particulate matter (PM2.5), behaviors, and factors that influence air quality and asthma symptoms in the urban homes of children (ages 6-10) with asthma; one cohort had cigarette smoke exposure in the home (n = 13) and the other did not (n = 22). Exposure data included measurements every 5 minutes for a month. RESULTS In the entire study population, a large contributor to elevations in indoor PM2.5 above 35 μg/m3 was not using the stove hood when cooking (8.5% higher, CI 3.1-13.9%, p<0.005). Median PM values during cooking times were 0.88 μg/m3 higher than those during non-cooking times (95% CI 0.33-1.42). Mean monthly household PM2.5 level was significantly related to the presence of a cigarette smoker in the home (10.1 μg/m3 higher, 95% CI 5.2-15.1, p<0.001) when controlling for use of the stove hood and proximity to major roadway. There was a trend toward increased odds of persistent asthma with increases in average monthly PM2.5 (OR 1.1, 95% CI 0.97-1.3, p = 0.16). CONCLUSIONS Consideration of only outdoor PM2.5 may obscure potentially modifiable risks for asthma symptoms. Specifically, this preliminary study suggests that cooking behaviors may contribute to the burden of PM2.5 in the homes of children with asthma and thus to asthma symptoms.
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Affiliation(s)
- Stephanie M. Holm
- UCSF Benioff Children’s Hospital Oakland, Oakland, CA, United States of America
- University of California Berkeley, School of Public Health, Division of Epidemiology, Berkeley, CA, United States of America
- University of California San Francisco, Division of Occupational and Environmental Medicine, San Francisco, CA, United States of America
| | - John Balmes
- University of California San Francisco, Division of Occupational and Environmental Medicine, San Francisco, CA, United States of America
- University of California Berkeley, School of Public Health, Division of Environmental Health Sciences, Berkeley, CA, United States of America
| | - Dan Gillette
- University of California Berkeley, Center for Information Technology Research in the Interest of Society, Berkeley, CA, United States of America
| | - Kris Hartin
- University of Washington, Department of Environmental and Occupational Health Sciences, Seattle, WA, United States of America
| | - Edmund Seto
- University of Washington, Department of Environmental and Occupational Health Sciences, Seattle, WA, United States of America
| | - David Lindeman
- University of California Berkeley, Center for Information Technology Research in the Interest of Society, Berkeley, CA, United States of America
| | - Dianna Polanco
- University of California Berkeley, Center for Information Technology Research in the Interest of Society, Berkeley, CA, United States of America
| | - Edward Fong
- Department of Pediatrics, Kapiolani Medical Center for Women and Children, Honolulu, HI, United States of America
- University of Hawaii-Manoa John A. Burns School of Medicine, Honolulu, HI, United States of America
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Nardone A, Neophytou AM, Balmes J, Thakur N. Ambient Air Pollution and Asthma-Related Outcomes in Children of Color of the USA: a Scoping Review of Literature Published Between 2013 and 2017. Curr Allergy Asthma Rep 2018; 18:29. [PMID: 29663154 PMCID: PMC6198325 DOI: 10.1007/s11882-018-0782-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [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] [Indexed: 12/12/2022]
Abstract
PURPOSE OF REVIEW Given racial disparities in ambient air pollution (AAP) exposure and asthma risk, this review offers an overview of the literature investigating the ambient air pollution-asthma relationship in children of color between 2013 and 2017. RECENT FINDINGS AAP is likely a key contributor to the excess burden of asthma in children of color due to pervasive exposure before birth, at home, and in school. Recent findings suggest that psychosocial stressors may modify the relationship between AAP and asthma. The effect of AAP on asthma in children of color is likely modulated by multiple unique psychosocial stressors and gene-environment interactions. Although children of color are being included in asthma studies, more research is still needed on impacts of specific criteria pollutants throughout the life course. Additionally, future studies should consider historical factors when analyzing current exposure profiles.
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Affiliation(s)
- Anthony Nardone
- University of California, San Francisco-University of California Berkeley Joint Medical Program, Berkeley, USA
- Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley, Berkeley, USA
| | - Andreas M Neophytou
- Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley, Berkeley, USA
| | - John Balmes
- Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley, Berkeley, USA
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of California, San Francisco, San Francisco, USA
| | - Neeta Thakur
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of California, San Francisco, San Francisco, USA
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Sood A, Assad NA, Barnes PJ, Churg A, Gordon SB, Harrod KS, Irshad H, Kurmi OP, Martin WJ, Meek P, Mortimer K, Noonan CW, Perez-Padilla R, Smith KR, Tesfaigzi Y, Ward T, Balmes J. ERS/ATS workshop report on respiratory health effects of household air pollution. Eur Respir J 2018; 51:51/1/1700698. [PMID: 29301918 DOI: 10.1183/13993003.00698-2017] [Citation(s) in RCA: 68] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Accepted: 08/08/2017] [Indexed: 12/18/2022]
Abstract
Exposure to household air pollution (HAP) from solid fuel combustion affects almost half of the world population. Adverse respiratory outcomes such as respiratory infections, impaired lung growth and chronic obstructive pulmonary disease have been linked to HAP exposure. Solid fuel smoke is a heterogeneous mixture of various gases and particulates. Cell culture and animal studies with controlled exposure conditions and genetic homogeneity provide important insights into HAP mechanisms. Impaired bacterial phagocytosis in exposed human alveolar macrophages possibly mediates several HAP-related health effects. Lung pathological findings in HAP-exposed individuals demonstrate greater small airways fibrosis and less emphysema compared with cigarette smokers. Field studies using questionnaires, air pollution monitoring and/or biomarkers are needed to better establish human risks. Some, but not all, studies suggest that improving cookstove efficiency or venting emissions may be associated with reduced respiratory symptoms, lung function decline in women and severe pneumonia in children. Current studies focus on fuel switching, stove technology replacements or upgrades and air filter devices. Several governments have initiated major programmes to accelerate the upgrade from solid fuels to clean fuels, particularly liquid petroleum gas, which provides research opportunities for the respiratory health community.
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Affiliation(s)
- Akshay Sood
- University of New Mexico School of Medicine, Albuquerque, NM, USA
| | - Nour A Assad
- University of New Mexico School of Medicine, Albuquerque, NM, USA
| | - Peter J Barnes
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Andrew Churg
- University of British Columbia, Vancouver, BC, Canada
| | | | - Kevin S Harrod
- University of Alabama at Birmingham, Birmingham, AL, USA
| | - Hammad Irshad
- Lovelace Respiratory Research Institute, Albuquerque, NM, USA
| | | | | | - Paula Meek
- University of Colorado at Denver, Denver, CO, USA
| | | | | | | | - Kirk R Smith
- University of California School of Public Health, Berkeley, CA, USA
| | | | - Tony Ward
- University of Montana, Missoula, MT, USA
| | - John Balmes
- University of California School of Public Health, Berkeley, CA, USA.,University of California, San Francisco, CA, USA
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Affiliation(s)
- George Thurston
- 1 Department of Environmental Medicine.,2 Department of Population Health New York University School of Medicine New York, New York and
| | - John Balmes
- 3 School of Public Health University of California at Berkeley Berkeley, California
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