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Background:
Acute exposure to ambient particulate matter <2.5μ⁢m in aerodynamic diameter (PM2.5) has been associated with adult psychiatric exacerbations but has not been studied in children. Objectives: Our objectives were to estimate the association between acute exposures to ambient PM2.5 and psychiatric emergency department (ED) utilization and to determine if it is modified by community deprivation. Methods: We used a time-stratified case-crossover design to analyze all pediatric, psychiatric ED encounters at Cincinnati Children’s Hospital Medical Center in Cincinnati, Ohio, from 2011 to 2015 (𝑛=13,176). Conditional logistic regression models adjusted for temperature, humidity, and holiday effects were used to estimate the odds ratio (OR) for a psychiatric ED visit 0–3 d after ambient PM2.5 exposures, estimated at residential addresses using a spatiotemporal model. Results: A 10⁢-μ⁢g/m3 increase in PM2.5 was associated with a significant increase in any psychiatric ED utilization 1 [OR=1.07 (95% CI: 1.02, 1.12)] and 2 [OR=1.05 (95% CI: 1.00, 1.10)] d later. When stratified by visit reason, associations were significant for ED visits related to adjustment disorder {e.g., 1-d lag [OR=1.24 (95% CI: 1.02, 1.52)] and suicidality 1-d lag [OR=1.44 (95% CI: 1.03, 2.02)]}. There were significant differences according to community deprivation, with some lags showing stronger associations among children in high versus low deprivation areas for ED visits for anxiety {1-d lag [OR=1.39 (95% CI: 0.96, 2.01) vs. 0.85 (95% CI: 0.62, 1.17)] and suicidality same day [OR=1.98 (95% CI: 1.22, 3.23) vs. 0.93 (95% CI: 0.60, 1.45)]}. In contrast, for some lags, associations with ED visits for adjustment disorder were weaker for children in high-deprivation areas {1-d lag [OR=1.00 (95% CI: 0.76, 1.33) vs. 1.50 (95% CI: 1.16, 1.93)]}. Discussion: These findings warrant additional research to confirm the associations in other populations.

Published Sep 25, 2019

Brokamp, C., Strawn, J. R., Beck, A. F., & Ryan, P. (2019). Pediatric Psychiatric Emergency Department Utilization and Fine Particulate Matter: A Case-Crossover Study. Environmental Health Perspectives, 127(9). https://doi.org/10.1289/EHP4815

In 2013, Allen Harim Foods purchased the former site of a Vlasic Pickle plant in Millsboro, Delaware, and proposed to convert the site into a poultry processing plant that would process approximately two million birds weekly. This generated concerns about the proposed plant’s potential to impact health and quality of life among residents. We conducted a rapid health impact assessment (HIA) of the proposed plant to assess baseline environmental health issues in the host community and projected impacts. The scoping and baseline assessment revealed social, economic, and health disparities in the region. We also determined that residents in the area were already underserved and overburdened with pollution from multiple environmental hazards near the proposed plant including two sites contaminated with hazardous wastes, a power plant, and another poultry processing plant. The projected size and amount of poultry to be processed at the plant would likely cause increased levels of air, soil and water pollution, additional odor issues, and increased traffic and related pollution and safety issues. The information generated from the HIA formed the basis of a campaign to raise awareness about potential problems associated with the new facility and to foster more engagement of impacted residents in local decision-making about the proposed plant. In the end, the HIA helped concerned residents oppose the new poultry processing plant. This case study provides an example of how HIAs can be used as a tool to educate residents, raise awareness about environmental justice issues, and enhance meaningful engagement in local environmental decision-making processes.

Published Sep 16, 2019

Baskin-Graves, L., Mullen, H., Aber, A., Sinisterra, J., Ayub, K., Amaya-Fuentes, R., & Wilson, S. (2019). Rapid health impact assessment of a proposed poultry processing plant in Millsboro, Delaware. International Journal of Environmental Research and Public Health, 16(18). https://doi.org/10.3390/ijerph16183429

We examined the association between average annual fine particulate matter (PM2.5) and ozone and first hospital admissions of Medicare participants for stroke, chronic obstructive pulmonary disease (COPD), pneumonia, myocardial infarction (MI), lung cancer, and heart failure (HF). Annual average PM2.5 and ozone levels were estimated using high-resolution spatio-temporal models. We fit a marginal structural Cox proportional hazards model, using stabilized inverse probability weights (IPWs) to account for the competing risk of death and confounding. Analyses were then repeated after restricting to exposure levels below the current U.S. standards. The results showed that PM2.5 was significantly associated with an increased hazard of admissions for all studied outcomes; the highest observed being a 6.1% (95% CI: 5.9%–6.2%) increase in the hazard of admissions with pneumonia for each μg/m3 increase in particulate levels. Ozone was also significantly associated with an increase in the risk of first hospital admissions of all outcomes. The hazard of pneumonia increased by 3.0% (95% CI: 2.9%–3.1%) for each ppb increase in the ozone level. Our results reveal a need to regulate long-term ozone exposure, and that associations persist below current PM2.5 standards.

Published Sep 1, 2019

Danesh Yazdi, M., Wang, Y., Di, Q., Zanobetti, A., & Schwartz, J. (2019). Long-term exposure to PM2.5 and ozone and hospital admissions of Medicare participants in the Southeast USA. Environment International, 130, 104879. https://doi.org/10.1016/J.ENVINT.2019.05.073

Although growing evidence links air pollution to stroke incidence, less is known about the effect of air pollution on atrial fibrillation (AF), an important risk factor for stroke. OBJECTIVES: We assessed the associations between air pollution and incidence of AF and stroke. We also sought to characterize the shape of pollutant–disease relationships. METHODS: The population-based cohort comprised 5,071,956 Ontario residents, age 35–85 y and without the diagnoses of both outcomes on 1 April 2001 and was followed up until 31 March 2015. AF and stroke cases were ascertained using health administrative databases with validated algorithms. Based on annual residential postal codes, we assigned 5-y running average concentrations of fine particulate matter (PM2:5), nitrogen dioxide (NO2), and ozone (O3) from satellite-derived data, a land-use regression model, and a fusion-based method, respectively, as well as redox-weighted averages of NO2 and O3 (Ox) for each year. Using Cox proportional hazards models, we estimated the hazard ratios (HRs) and 95% confidence intervals (95% CIs) of AF and stroke with each of these pollutants, adjusting for individual and neighborhood-level variables. We used newly developed nonlinear risk models to characterize the shape of pollutant–disease relationships. RESULTS: Between 2001 and 2015, we identified 313,157 incident cases of AF and 122,545 cases of stroke. Interquartile range increments of PM2:5, NO2, O3, and Ox were associated with increases in the incidence of AF [HRs (95% CIs): 1.03 (1.01, 1.04), 1.02 (1.01, 1.03), 1.01 (1.00, 1.02), and 1.01 (1.01, 1.02), respectively] and the incidence of stroke [HRs (95% CIs): 1.05 (1.03, 1.07), 1.04 (1.01, 1.06), 1.05 (1.03, 1.06), and 1.05 (1.04, 1.06), respectively]. Associations of similar magnitude were found in various sensitivity analyses. Furthermore, we found a near-linear association for stroke with PM2:5, whereas Ox-stroke, PM2:5-, and Ox-AF relationships exhibited sublinear shapes. CONCLUSIONS: Air pollution was associated with stroke and AF onset, even at very low concentrations. https://doi.org/10.1289/EHP4883.

Published Aug 26, 2019

Shin, S., Burnett, R. T., Kwong, J. C., Hystad, P., Van Donkelaar, A., Brook, J. R., Goldberg, M. S., Tu, K., Copes, R., Martin, R. V., Liu, Y., Kopp, A., & Chen, H. (2019). Ambient air pollution and the risk of atrial fibrillation and stroke: A population based cohort study. Environmental Health Perspectives, 127(8), 1–15. https://doi.org/10.1289/EHP4883

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.

Published Aug 26, 2019

Payne-Sturges, D. C., Marty, M. A., Perera, F., Miller, M. D., Swanson, M., Ellickson, K., Cory-Slechta, D. A., Ritz, B., Balmes, J., Anderko, L., Talbott, E. O., Gould, R., & Hertz-Picciotto, I. (2019). Healthy air, healthy brains: Advancing air pollution policy to protect children’s health. American Journal of Public Health, 109(4), 550–554. https://doi.org/10.2105/AJPH.2018.304902

The search for the genetic factors underlying complex neuropsychiatric disorders has proceeded apace in the past decade. Despite some advances in identifying genetic variants associated with psychiatric disorders, most variants have small individual contributions to risk. By contrast, disease risk increase appears to be less subtle for disease-predisposing environmental insults. In this study, we sought to identify associations between environmental pollution and risk of neuropsychiatric disorders. We present exploratory analyses of 2 independent, very large datasets: 151 million unique individuals, represented in a United States insurance claims dataset, and 1.4 million unique individuals documented in Danish national treatment registers. Environmental Protection Agency (EPA) county-level environmental quality indices (EQIs) in the US and individual-level exposure to air pollution in Denmark were used to assess the association between pollution exposure and the risk of neuropsychiatric disorders. These results show that air pollution is significantly associated with increased risk of psychiatric disorders. We hypothesize that pollutants affect the human brain via neuroinflammatory pathways that have also been shown to cause depression-like phenotypes in animal studies.

Published Aug 20, 2019

Khan, A., Plana-Ripoll, O., Antonsen, S., Brandt, J., Geels, C., Landecker, H., Sullivan, P. F., Pedersen, C. B., & Rzhetsky, A. (2019). Environmental pollution is associated with increased risk of psychiatric disorders in the US and Denmark. PLOS Biology, 17(8), e3000353. https://doi.org/10.1371/JOURNAL.PBIO.3000353

BACKGROUND: Telomere length is a molecular marker of biological aging. OBJECTIVE: Here we investigated whether early-life exposure to residential air pollution was associated with leukocyte telomere length (LTL) at 8 y of age. METHODS: In a multicenter European birth cohort study, HELIX (Human Early Life Exposome) (n= 1,396), we estimated prenatal and 1-y childhood exposure to nitrogen dioxide (NO2), particulate matter with aerodynamic diameter ≤2:5 lm (PM2:5), and proximity to major roads. Average relative LTL was measured using quantitative real-time polymerase chain reaction (qPCR). Effect estimates of the association between LTL and prenatal, 1-y childhood air pollution, and proximity to major roads were calculated using multiple linear mixed models with a random cohort effect and adjusted for relevant covariates. RESULTS: LTL was inversely associated with prenatal and 1-y childhood NO2 and PM2:5 exposures levels. Each standard deviation (SD) increase in prenatal NO2 was associated with a −1:5% (95% CI: −2:8, −0:2) change in LTL. Prenatal PM2:5 was nonsignificantly associated with LTL (−0:7% per SD increase; 95% CI: −2:0, 0.6). For each SD increment in 1-y childhood NO2 and PM2:5 exposure, LTL shortened by −1:6% (95% CI: −2:9, −0:4) and −1:4% (95% CI: −2:9, 0.1), respectively. Each doubling in residential distance to nearest major road during childhood was associated with a 1.6% (95% CI: 0.02, 3.1) lengthening in LTL. CONCLUSION: Lower exposures to air pollution during pregnancy and childhood were associated with longer telomeres in European children at 8 y of age. These results suggest that reductions in traffic-related air pollution may promote molecular longevity, as exemplified by telomere length, from early life onward.

Published Aug 8, 2019

Clemente, D. B. P., Vrijheid, M., Martens, D. S., Bustamante, M., Chatzi, L., Danileviciute, A., De Castro, M., Grazuleviciene, R., Gutzkow, K. B., Lepeule, J., Maitre, L., McEachan, R. R. C., Robinson, O., Schwarze, P. E., Tamayo, I., Vafeiadi, M., Wright, J., Slama, R., Nieuwenhuijsen, M., & Nawrot, T. S. (2019). Prenatal and childhood traffic-related air pollution exposure and telomere length in european children: The HELIX project. Environmental Health Perspectives, 127(8), 1–8. https://doi.org/10.1289/EHP4148

Telomere shortening is associated with early mortality and chronic disease. Recent studies indicate that environmental exposures, including urban and traffic-related air pollution, may shorten telomeres. Associations between exposure to household air pollution from solid fuel stoves and telomere length have not been evaluated. METHODS: Among 137 rural Chinese women using biomass stoves (mean = 55 y of age), we measured 48-h personal exposures to fine particulate matter [PM ≤ 2:5 μm in aerodynamic diameter (PM2:5)] and black carbon and collected oral DNA on up to three occasions over a period of 2.5 y. Relative telomere length (RTL) was quantified using a modified real-time polymerase chain reaction protocol. Mixed effects regression models were used to investigate the exposure-response associations between household air pollution and RTL, adjusting for key sociodemographic, behavioral, and environmental covariates. RESULTS: Women’s daily exposures to air pollution ranged from 13-1,136 μg=m3 for PM2:5 (mean = 154) and 0:1-34 μg=m3 for black carbon (mean = 3:6). Natural cubic spline models indicated a mostly linear association between increased exposure to air pollution and shorter RTL, except at very high concentrations where there were few observations. We thus modeled the linear associations with all observations, excluding the highest 3% and 5% of exposures. In covariate-adjusted models, an interquartile range (IQR) increase in exposure to black carbon (3:1 μg=m3) was associated with shorter RTL [all observations: −0:27 (95% CI: −0:48, −0:06); excluding highest 5% exposures: −1:10 (95% CI: −1:63, −0:57)]. Further adjustment for outdoor temperature brought the estimates closer to zero [all observations: −0:15 (95% CI: −0:36, 0.06); excluding highest 5% exposures: −0:68 (95% CI: −1:26, −0:10)]. Models with PM2:5 as the exposure metric followed a similar pattern. CONCLUSION: Telomere shortening, which is a biomarker of biological aging and chronic disease, may be associated with exposure to air pollution in settings where household biomass stoves are commonly used.

Published Aug 8, 2019

Li, S., Yang, M., Carter, E., Schauer, J. J., Yang, X., Ezzati, M., Goldberg, M. S., & Baumgartner, J. (2019). Exposure-response associations of household air pollution and buccal cell telomere length in women using biomass stoves. Environmental Health Perspectives, 127(8), 1–11. https://doi.org/10.1289/EHP4041

BACKGROUND: Surrounding green, air pollution, and noise have been associated with cardiometabolic diseases, but most studies have assessed only one of these correlated exposures. OBJECTIVES: We aimed to evaluate associations of combined exposures to green, air pollution, and road traffic noise with cardiometabolic diseases. METHODS: In this cross-sectional study, we studied associations between self-reported physician-diagnosed diabetes, hypertension, heart attack, and stroke from a Dutch national health survey of 387,195 adults and residential surrounding green, annual average air pollutant concentrations [including particulate matter with aerodynamic diameter ≤10 μm (PM10), PM with aerodynamic diameter ≤2:5 μm (PM2:5), nitrogen dioxide (NO2), and oxidative potential (OP) with the dithiothreitol (DTT) assay (OPDTT)] and road traffic noise. Logistic regression models were used to analyze confounding and interaction of surrounding green, air pollution, and noise exposure. RESULTS: In single-exposure models, surrounding green was inversely associated with diabetes, while air pollutants (NO2, OPDTT) and road traffic noise were positively associated with diabetes. In two-exposure analyses, associations with green and air pollution were attenuated but remained. The association between road traffic noise and diabetes was reduced to unity when adjusted for surrounding green or air pollution. Air pollution and surrounding green, but not road traffic noise, were associated with hypertension in single-exposure models. The weak inverse association of surrounding green with hypertension attenuated and lost significance when adjusted for air pollution. Only PM2:5 was associated with stroke and heart attack. CONCLUSIONS: Studies including only one of the correlated exposures surrounding green, air pollution, and road traffic noise may overestimate the association of diabetes and hypertension attributed to the studied exposure. https://doi.org/10.1289/EHP3857.

Published Aug 8, 2019

Klompmaker, J. O., Janssen, N. A. H., Bloemsma, L. D., Gehring, U., Wijga, A. H., Brink, C. Vanden, Lebret, E., Brunekreef, B., & Hoek, G. (2019). Associations of combined exposures to surrounding green, air pollution, and road traffic noise with cardiometabolic diseases. Environmental Health Perspectives, 127(8), 1–15. https://doi.org/10.1289/EHP3857

In the final sentence of the Acknowledgments section, the sentence “Findings and conclusions of this research are those of the authors and do not necessarily represent the views of the National Center for Health Statistics (NCHS) Research Data Center (RDC), the NCHS, the U.S. EPA, or the Centers for Disease Control and Prevention” should be “Findings and conclusions of this research are those of the authors and do not necessarily represent the views of the National Center for Health Statistics (NCHS) Research Data Center (RDC), the NCHS, the U.S. EPA, the Centers for Disease Control and Prevention, or Cornerstone Research.” The authors apologize for the error.

Published Jul 24, 2019

Pope, C. A., Lefler, J. S., Ezzati, M., Higbee, J. D., Marshall, J. D., Kim, S. Y., Bechle, M., Gilliat, K. S., Vernon, S. E., Robinson, A. L., & Burnett, R. T. (2019). Erratum: Mortality risk and fine particulate air pollution in a large, representative cohort of U.S. adults (Environ Health Perspect, (2019), 127, 7, 10.1289/EHP4438). Environmental Health Perspectives, 127(9), 099002–1. https://doi.org/10.1289/EHP6182