Estimated effects of air pollution and space-time-activity on cardiopulmonary outcomes in healthy adults: A repeated measures study

Biomonitoring of potentially toxic elements at two differentially anthropized areas of the "Land of Fires" (S Italy)

In this study, contamination by potentially toxic elements (PTEs) was investigated in two areas of southern Italy with different levels of human impact, both near the "Land of Fires," known for illegal waste burning. The moss Scorpiurum circinatum was used for biomonitoring by placing moss bags at six sites: an un-urbanized estate in the forest of Palazzo Reale Carditello (CF) and an industrially polluted area on the outskirts of Giugliano in Campania (GC). Mount Faito (MF) served as a control site, free from pollution sources. Moss bags were exposed for 21, 42, and 63 days, and samples were analyzed for PTEs (As, Cd, Cr, Cu, Hg, Pb, Sb), ultrastructural damage, oxidative stress, and antioxidant response. At the control site, bioaccumulation and oxidative stress were negligible, and moss ultrastructure remained unchanged. However, moss exposed near the "Land of Fires" accumulated significant PTEs. After just 21 days, As, Cu, and Hg levels reached 2.2 mg/kg, 17 mg/kg, and 0.06 mg/kg respectively, triggering oxidative stress, an antioxidant response, and noticeable ultrastructural damage. Interestingly, Scorpiurum circinatum exhibited similar negative biological effects at both contaminated sites, despite their differing environmental conditions. This suggests that toxic fumes from illegal waste incineration are spreading beyond anthropized areas. The findings confirm the moss's effectiveness as a bioindicator and highlight the severe health risks posed by PTEs exposure, emphasizing the urgent need for intervention to mitigate this environmental and public health crisis.

Ozone exposure and cardiovascular disease: A narrative review of epidemiology evidence and underlying mechanisms

Ozone (O3) poses a significant global public health concern as it exerts adverse effects on human cardiovascular health. Nevertheless, there remains a lack of comprehensive understanding regarding the relationships between O3 exposure and the risk of cardiovascular diseases (CVD), as well as the underlying biological mechanisms. To address this knowledge gap, this narrative review meticulously summarizes the existing epidemiological evidence, susceptibility, and potential underlying biological mechanisms linking O3 exposure with CVD. An increasing body of epidemiological studies has demonstrated that O3 exposure heightens the incidence and mortality of CVD, including specific subtypes such as ischemic heart disease, hypertension, and heart failure. Certain populations display heightened vulnerability to these effects, particularly children, the elderly, obese individuals, and those with pre-existing conditions. Proposed biological mechanisms suggest that O3 exposure engenders respiratory and systemic inflammation, oxidative stress, disruption of autonomic nervous and neuroendocrine systems, as well as impairment of coagulation function, glucose, and lipid metabolism. Ultimately, these processes contribute to vascular dysfunction and the development of CVD. However, some studies have reported the absence of associations between O3 and CVD, or even potentially protective effects of O3. Inconsistencies among the literature may be attributed to inaccurate assessment of personal O3 exposure levels in epidemiologic studies, as well as confounding effects stemming from co-pollutants and temperature. Consequently, our findings underscore the imperative for further research, including the development of reliable methodologies for assessing personal O3 exposure, exploration of O3 exposure's impact on cardiovascular health, and elucidation of its biological mechanisms. These endeavors will consolidate the causal relationship between O3 and cardiovascular diseases, subsequently aiding efforts to mitigate the risks associated with O3 exposure.

Dynamic and stationary monitoring of air pollutant exposures and dose during marathons

Marathon running significantly increases breathing volumes and, consequently, air pollution inhalation doses. This is of special concern for elite athletes who ventilate at very high rates. However, race organizers and sport governing bodies have little guidance to support events scheduling to protect runners. A key limitation is the lack of hyper-local, high temporal resolution air quality data representative of exposure along the racecourse. This work aimed to understand the air pollution exposures and dose inhaled by athletes, by means of a dynamic monitoring methodology designed for road races. Air quality monitors were deployed during three marathons, monitoring nitrogen dioxide (NO2), ozone (O3), particulate matter (PMx), air temperature, and relative humidity. One fixed monitor was installed at the Start/Finish line and one mobile monitor followed the women elite runner pack. The data from the fixed monitors, deployed prior the race, described daily air pollution trends. Mobile monitors in combination with heatmap analysis facilitated the hyper-local characterization of athletes' exposures and helped identify local hotspots (e.g., areas prone to PM resuspension) which should be preferably bypassed. The estimation of inhaled doses disaggregated by gender and ventilation showed that doses inhaled by last finishers may be equal or higher than those inhaled by first finishers for O3 and PMx, due to longer exposures as well as the increase of these pollutants over time (e.g., 58.2 ± 9.6 and 72.1 ± 23.7 μg of PM2.5 for first and last man during Rome marathon). Similarly, men received significantly higher doses than women due to their higher ventilation rate, with differences of 31-114 μg for NO2, 79-232 μg for O3, and 6-41 μg for PMx. Finally, the aggregated data obtained during the 4 week- period prior the marathon can support better race scheduling by the organizers and provide actionable information to mitigate air pollution impacts on athletes' health and performance.

An observed nocturnal ozone transport event in the Sichuan Basin, Southwestern China

The ozone (O3) pollution in China drew lots of attention in recent years, and the Sichuan Basin (SCB) was one of the regions confronting worsening O3 pollution problem. Many previous studies have shown that regional transport is an important contributor to O3 pollution. However, very few features of the O3 profile during transport have been reported, especially in the border regions between different administrative divisions. In this study, we conducted tethered balloon soundings in SCB during the summer of 2020 and captured a nocturnal O3 transport event during the campaign. Vertically, the O3 transport occurred in the bottom of the residual layer, between 200 and 500 m above ground level. Horizontally, the transport pathway was directed from southeast to northwest based on the analysis of the wind field and air mass trajectories. The effect of transport in the residual layer on the surface O3 concentration was related to the spatial distribution of O3. For cities with high O3 concentrations in the upwind region, the transport process would bring clean air masses and abate pollution. For downwind lightly polluted cities, the transport process would slow down the decreasing or even increase the surface O3 concentration during the night. We provided observational facts on the profile features of a transboundary O3 transport event between two provincial administrative divisions, which implicated the importance of joint prevention and control measures. However, the sounding parameters were limited and the quantitative analysis was preliminary, more integrated, and thorough studies of this topic were called for in the future.

When and where to exercise: An assessment of personal exposure to urban tropical ambient airborne pollutants in Singapore

BACKGROUND

Physical activity is associated with health benefits and has been shown to reduce mortality risk. However, exposure to high levels of ambient fine particulate matter (PM2.5) during exercise can potentially reduce the health benefits of physical activity. This study aims to assess and compare the PM2.5 concentrations of different exercise venues in Singapore by their location attributes and time of day.

METHODS

Personal PM2.5 exposures (μg/m3) at 24 common outdoor exercise venues in Singapore over 49 sampling days were collected using real-time personal sensors from September 2017 to January 2020. Wilcoxon rank-sum test and Kruskal-Wallis test were used to compare PM2.5 concentrations between different timings (peak (0700-0900; 1800-2000) vs. non-peak (0600-0700; 0900-1800; 2000-2300); weekend vs. weekday), and location attributes (near major roads (<50 m) vs. away from major roads (≥50 m)). Multivariable linear regression models were used to assess the associations between location attributes, timings and ambient PM2.5 with personal PM2.5 concentration, adjusting for potential confounders.

RESULTS

Compared with peak hours, exercising during non-peak hours was associated with a significantly lower PM2.5 exposure (median, 17.8 μg/m3 during peak vs. 14.5 μg/m3 during non-peak; P = 0.006). Exercise venues away from major roads have significantly lower PM2.5 concentrations as compared to those located next to major roads (median, 14.4 μg/m3 away from major roads vs. 18.5 μg/m3 next to major roads; P < 0.001). Individuals who exercised in parks experienced the highest PM2.5 exposure (median, 55.0 μg/m3) levels in the afternoon during 1400-1500. Furthermore, ambient PM2.5 concentration was significantly and positively associated with personal PM2.5 exposure (β = 0.85, P < 0.001).

CONCLUSIONS

Our findings suggest that exercising outdoors in the urban environment exposes individuals to differential levels of PM2.5 at different times of the day. Further research should investigate a wider variety of outdoor exercise venues, explore different types of air pollutants, and consider the varying activity patterns of individuals.

Obesity-related cardiometabolic indicators modify the associations of personal noise exposure with heart rate variability: A further investigation on the Study among Obese and Normal-weight Adults (SONA)

Elucidating the associations between environmental noise and heart rate variability (HRV) would be beneficial for the prevention and control of detrimental cardiovascular changes. Obese people have been found to manifest heightened susceptibility to the adverse effects of noise on HRV. However, the underlying mechanisms remain unclear. Based on 53 normal-weight and 44 obese young adults aged 18-26 years in Beijing, China, this study aimed to investigate the role of obesity-related cardiometabolic indicators for associations between short-term environmental noise exposure and HRV in the real-world context. The participants underwent personal noise exposure and ambulatory electrocardiogram monitoring using portable devices at 5-min intervals for 24 continuous hours. Obesity-related blood pressure, glucose and lipid metabolism, and inflammatory indicators were subsequently examined. Generalized mixed-effect models were used to estimate the associations between noise exposure and HRV parameters. The C-peptide, homeostasis model assessment of insulin resistance (HOMA-IR), and leptin levels were higher in obese participants compared to normal-weight participants. We observed amplified associations between short-term noise exposure and decreases in HRV among participants with higher C-peptide, HOMA-IR, and leptin levels. For instance, a 1 dB(A) increment in 3 h-average noise exposure level preceding each measurement was associated with changes of -0.20% (95%CI: -0.45%, 0.04%) and -1.35% (95%CI: -1.85%, -0.86%) in standard deviation of all normal to normal intervals (SDNN) among participants with lower and higher C-peptide levels, respectively (P for interaction <0.05). Meanwhile, co-existing fine particulate matter (PM2.5) could amplify the associations between noise and HRV among obese participants and participants with higher C-peptide, HOMA-IR, and leptin levels. The more apparent associations of short-term exposure to environmental noise with HRV and the effect modification by PM2.5 may be partially explained by the higher C-peptide, HOMA-IR, and leptin levels of obese people.

The potential role of plasma miR-4301 in PM2.5 exposure-associated lung function reduction

The effect of PM_2.5 exposure on lung function reduction has been well-documented, but the underlying mechanism remains unclear. MiR-4301 may be involved in regulating pathways related to lung injury/repairment, and this study aimed to explore the potential role of miR-4301 in PM_2.5 exposure-associated lung function reduction. A total of 167 Wuhan community nonsmokers were included in this study. Lung function was measured and personal PM_2.5 exposure moving averages were evaluated for each participant. Plasma miRNA was determined by real-time polymerase chain reaction. A generalized linear model was conducted to assess the relationships among personal PM_2.5 moving average concentrations, lung function, and plasma miRNA. The mediation effect of miRNA on the association of personal PM_2.5 exposure with lung function reduction was estimated. Finally, we performed pathway enrichment analysis to predict the underlying pathways of miRNA in lung function reduction from PM_2.5 exposure. We found that each 10 μg/m³ increase in the 7-day personal PM_2.5 moving average concentration (Lag0-7) was related to a 46.71 mL, 1.15%, 157.06 mL/s, and 188.13 mL/s reductions in FEV₁, FEV₁/FVC, PEF, and MMF, respectively. PM_2.5 exposure was negatively associated with plasma miR-4301 expression levels in a dose‒response manner. Additionally, each 1% increase in miR-4301 expression level was significantly associated with a 0.36 mL, 0.01%, 1.14 mL/s, and 1.28 mL/s increases in FEV₁, FEV₁/FVC, MMF, and PEF, respectively. Mediation analysis further revealed that decreased miR-4301 mediated 15.6% and 16.8% of PM_2.5 exposure-associated reductions in FEV₁/FVC and MMF, respectively. Pathway enrichment analyses suggested that the wingless related-integration site (Wnt) signaling pathway might be one of the pathways regulated by miR-4301 in the reduction of lung function from PM_2.5 exposure. In brief, personal PM_2.5 exposure was negatively associated with plasma miR-4301 or lung function in a dose‒response manner. Moreover, miR-4301 partially mediated the lung function reduction associated with PM_2.5 exposure.

Greenness exposure: beneficial but multidimensional

Many studies have shown that greenness has beneficial health effects, particularly on psychological and cardiovascular outcomes. In this narrative review, we provide a synthesis of knowledge regarding greenness exposure and respiratory health. The following outcomes were reviewed: respiratory mortality, lung cancer mortality, lung cancer incidence, respiratory hospitalisations, lung function, COPD, and asthma. We identified 174 articles through a literature search in PubMed, of which 42 were eligible for inclusion in this review. The most common marker for greenness exposure was the normalised difference vegetation index (NDVI), which was used in 29 out of 42 papers. Other markers used were tree canopy cover, landcover/land-use, plant diversity, density of tall trees and subjectively perceived greenness. We found beneficial effects of greenness in most studies regarding respiratory mortality, lung cancer incidence, respiratory hospitalisations and lung function. For lung cancer mortality, asthma and COPD, the effects of greenness were less clear cut. While many aspects of greenness are beneficial, some aspects may be harmful, and greenness may have different health effects in different population subgroups. Future studies of greenness and respiratory diseases should focus on asthma and COPD, on effects in different population subgroups and on disentangling the health effects of the various greenness dimensions.

Associations of time-weighted individual exposure to ambient particulate matter with carotid atherosclerosis in Beijing, China

BACKGROUND

Time-location information (time spent on commuting, indoors and outdoors around residential and work places and physical activity) and infiltrated outdoor pollution was less considered estimating individual exposure to ambient air pollution. Studies investigating the association between individual exposure to particulate matter (PM) with aerodynamic diameter < 10 μm (PM₁₀) and < 2.5 μm (PM_2.5) and carotid atherosclerosis presented inconsistent results. Moreover, combined effect of pollutants on carotid atherosclerosis was not fully explored. We aimed to investigate the association between long-term individual time-weighted average exposure to PM_2.5 and PM₁₀ and the risk of carotid atherosclerosis, and further explore the overall effect of co-exposure to pollutants on carotid atherosclerosis.

METHODS

The study population included 3069 participants derived from the Beijing Health Management Cohort (BHMC) study. Daily concentration of ambient air pollutants was estimated by land-use regression model at both residential and work addresses, and one- and two-year time-weighted average individual exposure was calculated by further considering personal activity pattern and infiltration of ambient air pollution indoors. We explored the association of PM_2.5 and PM₁₀ with carotid atherosclerosis and pooled the overall effect of co-exposure to ambient air pollutants by quantile g-computation.

RESULTS

A significant association between time-weighted average exposure to PM_2.5 and PM₁₀ and carotid atherosclerosis was observed. Per interquartile range increase in two-year exposure to PM_2.5 (Hazard ratio (HR): 1.322, 95% confidence interval (CI): 1.219-1.434) and PM₁₀ (HR:1.213, 95% CI: 1.116-1.319) showed the strongest association with carotid atherosclerosis, respectively. Individuals in higher quartiles of pollutants were at higher risk for carotid atherosclerosis compared with those in the lowest quartile group. Concentration response functions documented the nearly linear and nonlinear relationship and interpreted the upward trends of the risk for carotid atherosclerosis with increasing level of pollutant concentrations. Moreover, effect estimates for the mixture of pollutants and carotid atherosclerosis were larger than any of the individual pollutants (HR (95% CI) was 1.510 (1.338-1.704) and 1.613 (1.428-1.822) per quartile increase for one-year and two-year time-weighted average exposure, respectively).

CONCLUSIONS

Individual time-weighted average exposure to PM_2.5 and PM₁₀ was associated with carotid atherosclerosis. Co-exposure to ambient air pollution was also positively associated with carotid atherosclerosis.

The short term adaptation of the autonomic nervous systems (ANS) by type of urban environment and ethnicity

BACKGROUND

Previous studies examined the effects of urban environments on the Autonomic Nervous System (ANS). These studies measured the effects of environments on Heart Rate Variability (HRV) averaging different time intervals to one value. Yet, the dynamics of change, reflecting the functions and their derivatives that describe the adaptation to the new environments remain unknown. In addition, ethnic differences in the ANS adaptation were not investigated.

METHOD

Forty-eight Arab and 24 Jewish women ages 20-35 years, all healthy, non-smokers were recruited by a snowball sample. Both groups were of a similar socioeconomic status and BMI distributions. Using a portable monitor, the HRV response was continuously analyzed for 35 min of sedentary sitting in each of the three environments: a park, a city center and a residential area. LF/HF polynomial function was adapted to describe the dynamic change in each environment for each ethnic group.

RESULTS

Green area exposure was associated with 90% immediate change while in built-up areas, the change in HRV is about 40% adaptive (changing gradually). The adaptive process of HRV may stabilize after 15 min in the city center yet not even after 35 min in the residential environment. The total change (immediate + adaptive) reached 24% in city centers and 10% in residential areas. Changes in HRV rates in the park and the city center environments were higher among Arab women as compared to Jewish women but similar between the two groups in the residential area. The distributions of LF/HF in each time cohort were normal, meaning that shifting the focus to analyze functions of change in HRV, opens the possibility to employ analytic methods that assume the normal distribution.

CONCLUSIONS

Changing the focus from average levels of HRV to functions of change and their derivatives brings new insight into the understanding of the ANS response to environmental challenges. ANS short term adaptation to different environments is gradual and spans differently both in magnitude of response and latencies between different environments. Importantly, in green areas, the response is immediate unlike the adaptation to urban environments that is significantly more gradual. The ethnic differences in ANS adaptation is also noteworthy. In addition, adaptation proceeesses are normaly distributed in each time cohort suggesting a possible novel ANS index.

Lung function decline associated with individual short-term exposure to PM1, PM2.5 and PM10 in patients with allergic rhinoconjunctivitis

BACKGROUND

The susceptibility of allergic rhinoconjunctivitis (ARC) patients to air pollution has yet to be clarified.

OBJECTIVES

Based on a repeated measurement panel study, we explored the association of short-term PM exposure with lung function in ARC patients and to further identify the susceptible populations.

METHODS

Personal PM exposure, including PM₁, PM_2.5 and PM₁₀, was monitored consecutively for three days before outcomes measurements. Lung function indices including forced vital capacity (FVC), forced expiratory volume in 1 s (FEV₁), peak expiratory flow (PEF), and forced expiratory flow at 25-75 % of the vital capacity (FEF_25-75) were measured. Serum total immunoglobulin E (IgE), specific-allergen IgE, blood eosinophil and basophils, and the symptoms severe scores were tested in each visit. Linear mixed effect models were applied to estimate the association between PM exposure and lung function. Furthermore, stratified and overlapping grouped populations based on IgE levels were implemented to characterize the modification role and the modulating threshold of IgE at which the association turned significantly negative.

RESULTS

Short-term PM personal exposure was associated with a significant decrease in lung function in ARC patients, especially for small airway respiratory indexes. The highest estimates occurred in PM₁, specifically a 10 μg/m³ increase reduced FEV₁/FVC, PEF and FEF_25-75 by 1.36 % (95 %CI: -2.29 to -0.43), 0.23 L/s (95 %CI: -0.42 to -0.03) and 0.18 L/s (95 %CI: -0.30 to -0.06), respectively. Notably, PM-induced decreases in lung function were stronger in patients with higher IgE levels (IgE ≥ 100 IU/mL), which were related to higher inflammatory cytokines and symptoms scores. Further, PM-associated lung function declines enhanced robustly and monotonically with increasing IgE concentration. Potential modulating thresholds of IgE occurred at 46.8-59.6 IU/mL for significant PM-lung function associations.

CONCLUSION

These novel findings estimated the short-term effects of PM on lung function in ARC patients, and the threshold values of IgE for the significant and robust associations.

Associations between long-term air pollution exposure and the incidence of cardiovascular diseases among American older adults

BACKGROUND & AIM

Numerous studies have linked air pollution with cardiovascular diseases. Fewer studies examined the associations at low concentration levels or assessed potential modifiers. Some investigations only examined hospitalizations, which can miss incident cases. This study aims to address these gaps through a nationwide cohort study of Medicare enrollees.

METHODS

Our study cohort comprise all Medicare enrollees (≥65 years old) continuously enrolled in the fee-for-service program and both Medicare part A and B across the contiguous U.S. from 2000 to 2016. We examined the associations of population-weighted ZIP code-level annual average PM2.5, NO2, and warm-season O3 (May-October), with the first diagnoses of atrial fibrillation (AF), congestive heart failure (CHF), and stroke. We fit multi-pollutant Cox proportional hazards models adjusted for individual demographic characteristics and area-level covariates. We further examined these associations at low pollutant concentration levels and the potential effect modifications by race/ethnicity and comorbidities (diabetes, hypertension, hyperlipidemia).

RESULTS

Elevated PM2.5 and NO2 levels were associated with increased incidence of AF, CHF, and stroke. For each 1 μg/m3 increase in annual PM2.5, hazard ratios (HRs) were 1.0059 (95%CI: 1.0054-1.0064), 1.0260 (95%CI: 1.0256-1.0264), and 1.0279 (95%CI: 1.0274-1.0284), respectively. For each1 ppb increase in annual NO2, HRs are 1.0057 (95%CI: 1.0056-1.0059), 1.0112 (95%CI: 1.0110-1.0113), and 1.0095 (95%CI: 1.0093-1.0096), respectively. For warm-season O3, each 1 ppb increase was associated with increased incidence of CHF (HR=1.0035, 95%CI: 1.0033-1.0037) and stroke (HR=1.0026, 95%CI: 1.0023-1.0028). Larger magnitudes of HRs were observed when restricted to pollutants levels lower than NAAQS standards. Generally higher risks were observed for Black people and diabetics.

CONCLUSIONS

Long-term exposure to PM2.5, NO2, and warm-season O3 were associated with increased incidence of cardiovascular diseases, even at low pollutant concentration levels. Black people and people with diabetes were found to be vulnerable populations.

The impact of black carbon (BC) on mode-specific galvanic skin response (GSR) as a measure of stress in urban environments

Previous research has shown that walking and cycling could help alleviate stress in cities, however there is poor knowledge on how specific microenvironmental conditions encountered during daily journeys may lead to varying degrees of stress experienced at that moment. We use objectively measured data and a robust causal inference framework to address this gap. Using a Bayesian Doubly Robust (BDR) approach, we find that black carbon exposure statistically significantly increases stress, as measured by Galvanic Skin Response (GSR), while cycling and while walking. Augmented Outcome Regression (AOR) models indicate that greenspace exposure and the presence of walking or cycling infrastructure could reduce stress. None of these effects are statistically significant for people in motorized transport. These findings add to a growing evidence-base on health benefits of policies aimed at decreasing air pollution, improving active travel infrastructure and increasing greenspace in cities.

Associations between personal noise exposure and heart rate variability were modified by obesity and PM2.5: The study among obese and normal-weight adults (SONA)

Noise pollution has been documented to increase the risks of cardiovascular disorders, which can be predicted by heart rate variability (HRV), nevertheless, there has been limited evidence on the modifiers of noise pollution. Environmental fine particulate matter (PM_2.5) and obesity status are both growing major concerns of cardiovascular disease burden. Our study aims to investigate whether these two factors may modify the associations between noise exposure and HRV indices. An investigation was performed on 97 (53 normal-weight and 44 obese) participants aged 18-26 years, with continuous 5-min personal exposure assessment and ambulatory electrocardiogram monitoring for 24 h. This study found that personal exposure to noise was associated with decreased HRV level and imbalanced cardiac autonomic function, as indicated by decreases in standard deviation of normal-to-normal intervals (SDNN), square root of the mean squared differences of successive intervals (rMSSD), the percentage of R-R intervals that differ from each other by more than 50 ms (pNN50), low-frequency (LF) power, high-frequency (HF) power, and increases in LF-HF-Ratio. Stronger associations between personal noise exposure and HRV indices were observed among obese participants and participants with higher PM_2.5 exposure levels compared to their counterparts. For SDNN, a 1 dB(A) increment in personal noise exposure at 3h-average was associated with a 1.25% (95%CI: -1.64%, -0.86%) decrease among obese participants, and a 0.11% (95%CI: -0.38%, 0.16%) decrease among normal-weight participants (P for subgroup difference<0.001); and a 0.87% (95%CI: -1.20%, -0.54%) decrease among participants with higher PM_2.5 exposure levels, and a 0.22% (95%CI: -0.58%, 0.14%) decrease among participants with lower PM_2.5 exposure levels (P for subgroup difference = 0.008). Obesity and PM_2.5 may aggravate the adverse effects of noise on HRV, which has implications for targeted prevention of cardiovascular disease burden associated with noise pollution.

Investigating the relationship between mass concentration of particulate matter and reactive oxygen species based on residential coal combustion source tests

Particulate matter (PM) has been considered to be closely related to human health, especially fine particulate matter. However, whether PM mass concentration alone is a good indicator for health impact remains a challenging question. In this study, emissions from residential coal combustion (RCC), one of the important PM sources in northern China, were tested to examine the relationship between the emission factors of particle-generated reactive oxygen species (ROS) (EF_ROS) and PM (EF_PM). A total of 24 combinations of source tests were conducted, including eight types of coal with different geological maturities (two anthracites and six bituminous) burned in three types of stoves (one honeycomb coal stove, one old chunk stove, and one new chunk stove). Here, ROS was defined as generated hydroxyl radical (·OH) by PM, and results showed EF_ROS from 24 residential coal combustion varied greatly by nearly 20 times. EF_ROS ranged 0.78-14.85 and 2.99-12.91 mg kg^-1 for the emissions from honeycomb and chunk coals, respectively. Moreover, the correlation between EF_ROS and EF_PM was significantly positive in honeycomb coal emissions (r = 0.82, p < 0.05), but it was insignificant in chunk coal emissions (r = 0.07, p > 0.05). For honeycomb coal emissions, organic carbon (OC) was quite abundant in PM and it might be the predominant contributor to both EF_PM and EF_ROS, resulting in a strong and positive correlation. For chunk coal emissions, high EF_ROS was mainly related to relatively high metal emissions in AN and LVB, while the metals were not major components in PM, leading to a poor correlation between EF_PM and EF_ROS. Therefore, this study revealed that PM was not always positively correlated with ROS from residential coal burning, and the relationship was mainly determined by the compositions of PM, suggesting PM mass concentration alone may not be the best indicator for assessing health impacts.

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

BACKGROUND/OBJECTIVE

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

METHODS

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

RESULTS

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

CONCLUSION

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

Mortality risk associated with greenness, air pollution, and physical activity in a representative U.S. cohort

Several cohort studies suggest greenness is associated with decreased mortality risk. Potential confounding by or interactions between physical activity and air pollution remains unclear. This study evaluates associations of greenness, air pollution, and physical activity with mortality risk and investigates confounding and effect modification across these key risk factors. National Health Interview Survey (NHIS) data covering 1997-2014 were linked to the National Death Index to generate a cohort of 403,748 individuals with 39,528 deaths. Greenness, represented by census-tract Normalized Difference Vegetation Index (NDVI) for the seasonal period of May-October, was averaged over the years 2003-2016. Air pollution was estimated by census-tract level PM_2.5 concentrations from 1999 to 2015. Cox Proportional Hazard Models were used to estimate hazard ratios (HR) for differences in greenness, air pollution, and physical activity. Alternative models that evaluated potential confounding and stratified models that evaluated effect modification were examined. Mortality risks were associated with PM_2.5 (HR = 1.14, 95% CI: 1.09-1.19 per 10 μg/m³) and physical inactivity (1.49, 1.44-1.54 relative to sufficiently active), but not with greenness (1.01, 0.99-1.03 per IQR). The PM_2.5-mortality association was mitigated at high levels of greenness (1.05, 0.91-1.22). There was no strong evidence of confounding between air pollution, physical activity, and greenness. However, stratified analysis suggested effect modification for PM_2.5 and NDVI by physical activity. A significant protective greenness-mortality association was observed for only highly active individuals (0.91, 0.86-0.96). Also, relatively high PM_2.5-mortality HRs were observed for more physically active individuals (1.25, 1.12-1.40). PM_2.5 air pollution and physical inactivity are robustly associated with mortality risk. Greenness may be most beneficial and air pollution relatively harmful to highly active individuals. This analysis provides evidence that, in addition to not smoking, being physically active and living in a clean, green environment contributes to improved health and reduced risk of mortality.

An Investigation into Which Methods Best Explain Children’s Exposure to Traffic-Related Air Pollution

There have been several methods employed to quantify individual-level exposure to ambient traffic-related air pollutants (TRAP). These include an individual’s residential proximity to roads, measurement of individual pollutants as surrogates or markers, as well as dispersion and land use regression (LUR) models. Hopanes are organic compounds still commonly found on ambient particulate matter and are specific markers of combustion engine primary emissions, but they have not been previously used in personal exposure studies. In this paper, children’s personal exposures to TRAP were evaluated using hopanes determined from weekly integrated filters collected as part of a personal exposure study in Windsor, Canada. These hopane measurements were used to evaluate how well other commonly used proxies of exposure to TRAP performed. Several of the LUR exposure estimates for a range of air pollutants were associated with the children’s summer personal hopane exposures (r = 0.41–0.74). However, all personal hopane exposures in summer were more strongly associated with the length of major roadways within 500 m of their homes. In contrast, metrics of major roadways and LUR estimates were poorly correlated with any winter personal hopanes. Our findings suggest that available TRAP exposure indicators have the potential for exposure misclassification in winter vs. summer and more so for LUR than for metrics of major road density. As such, limitations are evident when using traditional proxy methods for assigning traffic exposures and these may be especially important when attempting to assign exposures for children’s key growth and developmental windows. If long-term chronic exposures are being estimated, our data suggest that measures of major road lengths in proximity to homes are a more-specific approach for assigning personal TRAP exposures.

Risk/benefit tradeoff of habitual physical activity and air pollution on chronic pulmonary obstructive disease: findings from a large prospective cohort study

BACKGROUND

The combined health impact of physical activity (PA) and air pollution on chronic obstructive pulmonary disease (COPD) remains unclear. We investigated the joint effects of habitual PA and long-term fine particulate matter (PM2.5) exposure on COPD incidence in a prospective population-based cohort.

METHODS

A prospective cohort study was conducted using data from the UK Biobank. Incidence of COPD was ascertained through linkage to the UK National Health Services register. Annual mean PM2.5 concentration was obtained using land use regression model. PA was measured by questionnaire and wrist-worn accelerometer. Cox proportional hazard models were applied to examine the associations between PM2.5, PA, and COPD. Additive and multiplicative interactions were examined.

RESULTS

A total of 266,280 participants free of COPD at baseline were included in data analysis with an average follow-up of 10.64 years, contributing to around 2.8 million person-years. Compared with participants with low level of PA, those with higher PA levels had lower risks of COPD incidence [hazard ratio (HR): 0.769, 95% CI: 0.720, 0.820 for moderate level; HR: 0.726, 95% CI: 0.679, 0.776 for high level]. By contrast, PM2.5 was associated with increased risk of COPD (HR per interquartile range increment: 1.065, 95% CI: 1.032, 1.099). Limited evidence of interaction between habitual PA and PM2.5 exposure was found. Similar results were found for accelerometer-measured PA.

CONCLUSIONS

Our study suggests that habitual PA could reduce risk of COPD incidence, and such protective effects were not affected by ambient PM2.5 pollution exposure.

Seasonal Disparity in the Effect of Meteorological Conditions on Air Quality in China Based on Artificial Intelligence

Air contamination is identified with individuals’ wellbeing and furthermore affects the sustainable development of economy and society. This paper gathered the time series data of seven meteorological conditions variables of Beijing city from 1 November 2013 to 31 October 2017 and utilized the generalized regression neural network optimized by the particle swarm optimization algorithm (PSO-GRNN) to explore seasonal disparity in the impacts of mean atmospheric humidity, maximum wind velocity, insolation duration, mean wind velocity and rain precipitation on air quality index (AQI). The results showed that in general, the most significant impacting factor on air quality in Beijing is insolation duration, mean atmospheric humidity, and maximum wind velocity. In spring and autumn, the meteorological diffusion conditions represented by insolation duration and mean atmospheric humidity had a significant effect on air quality. In summer, temperature and wind are the most significant variables influencing air quality in Beijing; the most important reason for air contamination in Beijing in winter is the increase in air humidity and the deterioration of air diffusion condition. This study investigates the seasonal effects of meteorological conditions on air contamination and suggests a new research method for air quality research. In future studies, the impacts of different variables other than meteorological conditions on air quality should be assessed.

Acute effect of fine particulate matter on blood pressure, heart rate and related inflammation biomarkers: A panel study in healthy adults

Epidemiological evidence of short-term fine particulate matter (PM2.5) exposure on blood pressure (BP), heart rate (HR) and related inflammation biomarkers has been inconsistent. We aimed to explore the acute effect of PM2.5 on BP, HR and the mediation effect of related inflammation biomarkers. A total of 32 healthy college students were recruited to perform 4 h of exposure at two sites with different PM2.5 concentrations in Wuhan between May 2019 and June 2019. The individual levels of PM2.5 concentration, BP and HR were measured hourly for each participant. Blood was drawn from each participant after each visit and we measured the levels of inflammation markers, including serum high-sensitivity C-reactive protein and plasma fibrinogen. Linear mixed-effect models were to explore the acute effect of PM2.5 exposure on BP, HR, and related inflammation biomarkers. In addition, we evaluated related inflammation biomarkers as the mediator in the association of PM2.5 and cardiovascular health indicators. The results showed that a 10 μg/m3 increment in PM2.5 concentration was associated with an increase of 0.84 (95% CI: 0.54, 1.15) beats/min (bpm) in HR and a 3.52% (95% CI: 1.60%, 5.48%) increase in fibrinogen. The lag effect model showed that the strongest effect on HR was observed at lag 3 h of PM2.5 exposure [1.96 bpm (95% CI: 1.19, 2.75)], but for fibrinogen, delayed exposure attenuated the association. Increased fibrinogen levels may account for 39.07% (P = 0.44) of the elevated HR by PM2.5. Null association was observed when it comes to short-term PM2.5 exposure and BP. Short-term exposure to PM2.5 was associated with elevated HR and increased fibrinogen levels. But our finding was not enough to suggest that exposure to PM2.5 might induce adverse cardiovascular effects by the pathway of inflammation.

Multiple environmental exposures along daily mobility paths and depressive symptoms: A smartphone-based tracking study

Few studies go beyond the residential environment in assessments of the environment-mental health association, despite multiple environments being encountered in daily life. This study investigated 1) the associations between multiple environmental exposures and depressive symptoms, both in the residential environment and along the daily mobility path, 2) examined differences in the strength of associations between residential- and mobility-based models, and 3) explored sex as a moderator. Depressive symptoms of 393 randomly sampled adults aged 18-65 were assessed using the Patient Health Questionnaire (PHQ-9). Respondents were tracked via global positioning systems- (GPS) enabled smartphones for up to 7 days. Exposure to green space (normalized difference vegetation index (NDVI)), blue space, noise (Lden) and air pollution (particulate matter (PM_2.5)) within 50 m and 100 m of each residential address and GPS point was computed. Multiple linear regression analyses were conducted separately for the residential- and mobility-based exposures. Wald tests were used to assess if the coefficients differed across models. Interaction terms were entered in fully adjusted models to determine if associations varied by sex. A significant negative relationship between green space and depressive symptoms was found in the fully adjusted residential- and mobility-based models using the 50 m buffer. No significant differences were observed in coefficients across models. None of the interaction terms were significant. Our results suggest that exposure to green space in the immediate environment, both at home and along the daily mobility path, is associated with a reduction in depressive symptoms. Further research is required to establish the utility of dynamic approaches to exposure assessment in studies on the environment and mental health.

Response of air quality to short-duration high-strength human tourism activities at a natural scenic spot: a case study in Zhangjiajie, China

Short-duration high-strength human tourism activities (SHHTA) can result in more air pollution emissions owing to increase motor vehicle usage, energy consumption and cooking fume emissions. Because of the strong uncertainty of human tourism behaviour, it is difficult to accurately assess the impact of SHHTA on air quality of natural scenic spots. To overcome this difficulty, we propose a novel ensemble empirical mode decomposition and detrended cross-correlation analysis (EEMD-DCCA) model to assess the influence of short-duration high-strength human tourism activities (SHHTA) on air quality. Zhangjiajie in China was selected as the study area. Hourly concentrations of NO₂ were analysed from 1 January 2016 to 31 December 2018 at two monitoring sites, in an urban area and a scenic spot. Through EEMD, the main modes of NO₂ with short-duration high-frequency were obtained for both sites. The DCCA method was used to study the cross-correlation relationship between high-frequency modes of NO2 for the urban area and scenic spot. The results show that high-frequency modes of NO₂ between the two sites displayed long-range cross-correlation at the 24-h time scale. Furthermore, the quantitative impacts of meteorological factors (e.g. precipitation, temperature, and wind speed) on the DCCA exponent for high-frequency modes of NO₂ at the two sites were investigated. The novel model proposed in this study is not restricted by the uncertainty of pollution emission inventory. The relationship between meteorological factors and DCCA exponents corresponds to the hypothesis that NO₂ pollution of the natural scenic spot mainly came from SHHTA.

Beyond air pollution at home: Assessment of personal exposure to PM2.5 using activity-based travel demand model and low-cost air sensor network data

Assessing personal exposure to air pollution is challenging due to the limited availability of human movement data and the complexity of modeling air pollution at high spatiotemporal resolution. Most health studies rely on residential estimates of outdoor air pollution instead which introduces exposure measurement error. Personal exposure for 100,784 individuals in Los Angeles County was estimated by integrating human movement data simulated from the Southern California Association of Governments (SCAG) activity-based travel demand model with hourly PM_2.5 predictions from my 500 m gridded model incorporating low-cost sensor monitoring data. Individual exposures were assigned considering PM_2.5 levels at homes, workplaces, and other activity locations. These dynamic exposures were compared to the residence-based exposures, which do not consider human movement, to examine the degree of exposure estimation bias. The results suggest that exposures were underestimated by 13% (range 5-22%) on average when human movement was not considered, and much of the error was eliminated by accounting for work location. Exposure estimation bias increased for people who exhibited higher mobility levels, especially for workers with long commute distances. Overall, the personal exposures of workers were underestimated by 22% (5-61%) relative to their residence-based exposures. For workers who commute >20 miles, their exposure levels can be at most underestimated by 61%. Omitting mobility resulted in underestimating exposures for people who reside in areas with cleaner air but work in more polluted areas. Similarly, exposures were overestimated for people living in areas with poorer air quality and working in cleaner areas. These could lead to differential estimation biases across racial, ethnic and socioeconomic lines that typically correlate with where people live and work and lead to important exposure and health disparities. This study demonstrates that ignoring human movement and spatiotemporal variability of air pollution could lead to differential exposure misclassification potentially biasing health risk assessments. These improved dynamic approaches can help planners and policymakers identify disadvantaged populations for which exposures are typically misrepresented and might lead to targeted policy and planning implications.

The joint association of physical activity and fine particulate matter exposure with incident dementia in elderly Hong Kong residents

OBJECTIVE

The evidence for the beneficial effects of physical activity (PA) and potentially detrimental effects of long-term exposure to fine particulate matter (PM_2.5) on neurodegeneration diseases is accumulating. However, their joint effects remain unclear. We evaluated joint associations of habitual PA and PM_2.5 exposure with incident dementia in a longitudinal elderly cohort in Hong Kong.

METHODS

A total of 57,775 elderly participants (≥65 years) without dementia were enrolled during 1998-2001 and followed up till 2011. Their information on PA and other relevant covariates were collected at baseline (1998-2001) by a standard self-administered questionnaire, including PA volumes (high, moderate, low, and inactive) and types (aerobic exercise, traditional Chinese exercise, stretching exercise, walking slowly, and no exercise). Their annual mean PM_2.5 exposures at the residential address were estimated using a satellite-based spatiotemporal model. We then adopted the Cox proportional hazards model to examine the joint associations with the incidence of all-cause dementia, Alzheimer's diseases, and vascular dementia on additive and multiplicative scales.

RESULTS

During the follow-up period, we identified 1,157 incident cases of dementia, including 642 cases of Alzheimer's disease and 324 cases of vascular dementia. A higher PA level was associated with a lower risk of incident all-cause dementia (hazard ratio (HR) for the high-PA volume was 0.59 (95% CI, 0.47, 0.75), as compared with the inactive-PA), whereas a high level of PM_2.5 was related to the higher risk with an HR of 1.15 (95%CI: 1.00, 1.33) compared with the low-level of PM_2.5. No clear evidence was observed of interaction between habitual PA (volume and type) and PM_2.5 inhalation to incident dementia on either additive or multiplicative scale.

CONCLUSION

Habitual PA and long-term PM_2.5 exposure were oppositely related to incident dementia in the Hong Kong aged population. The benefits of PA remain in people irrespective of exposure to air pollution.

Random forest model based fine scale spatiotemporal O3 trends in the Beijing-Tianjin-Hebei region in China, 2010 to 2017

Ambient ozone (O₃) concentrations have shown an upward trend in China and its health hazards have also been recognized in recent years. High-resolution exposure data based on statistical models are needed. Our study aimed to build high-performance random forest (RF) models based on training data from 2013 to 2017 in the Beijing-Tianjin-Hebei (BTH) region in China at a 0.01 ° × 0.01 ° resolution, and estimated daily maximum 8h average O₃ (O₃-8hmax) concentration, daily average O₃ (O₃-mean) concentration, and daily maximum 1h O₃ (O₃-1hmax) concentration from 2010 to 2017. Model features included meteorological variables, chemical transport model output variables, geographic variables, and population data. The test-R² of sample-based O₃-8hmax, O₃-mean and O₃-1hmax models were all greater than 0.80, while the R² of site-based and date-based model were 0.68-0.87. From 2010 to 2017, O₃-8hmax, O₃-mean, and O₃-1hmax concentrations in the BTH region increased by 4.18 μg/m³, 0.11 μg/m³, and 4.71 μg/m³, especially in more developed regions. Due to the influence of weather conditions, which showed high contribution to the model, the long-term spatial distribution of O₃ concentrations indicated a similar pattern as altitude, where high concentration levels were distributed in regions with higher altitude.

Predicting the Olea pollen concentration with a machine learning algorithm ensemble

Air pollution in large cities produces numerous diseases and even millions of deaths annually according to the World Health Organization. Pollen exposure is related to allergic diseases, which makes its prediction a valuable tool to assess the risk level to aeroallergens. However, airborne pollen concentrations are difficult to predict due to the inherent complexity of the relationships among both biotic and environmental variables. In this work, a stochastic approach based on supervised machine learning algorithms was performed to forecast the daily Olea pollen concentrations in the Community of Madrid, central Spain, from 1993 to 2018. Firstly, individual Light Gradient Boosting Machine (LightGBM) and artificial neural network (ANN) models were applied to predict the day of the year (DOY) when the peak of the pollen season occurs, resulting the estimated average peak date 149.1 ± 9.3 and 150.1 ± 10.8 DOY for LightGBM and ANN, respectively, close to the observed value (148.8 ± 9.8). Secondly, the daily pollen concentrations during the entire pollen season have been calculated using an ensemble of two-step GAM followed by LightGBM and ANN. The results of the prediction of daily pollen concentrations showed a coefficient of determination (r²) above 0.75 (goodness of the model following cross-validation). The predictors included in the ensemble models were meteorological variables, phenological metrics, specific site-characteristics, and preceding pollen concentrations. The models are state-of-the-art in machine learning and their potential has been shown to be used and deployed to understand and to predict the pollen risk levels during the main olive pollen season.

Short-term differences in cardiac function following controlled exposure to cookstove air pollution: The subclinical tests on volunteers exposed to smoke (STOVES) study

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.

Respiratory Effects of Exposure to Traffic-Related Air Pollutants During Exercise

Traffic-related air pollution (TRAP) is increasing worldwide. Habitual physical activity is known to prevent cardiorespiratory diseases and mortality, but whether exposure to TRAP during exercise affects respiratory health is still uncertain. Exercise causes inflammatory changes in the airways, and its interaction with the effects of TRAP or ozone might be detrimental, for both athletes exercising outdoor and urban active commuters. In this Mini-Review, we summarize the literature on the effects of exposure to TRAP and/or ozone during exercise on lung function, respiratory symptoms, performance, and biomarkers. Ozone negatively affected pulmonary function after exercise, especially after combined exposure to ozone and diesel exhaust (DE). Spirometric changes after exercise during exposure to particulate matter and ultrafine particles suggest a decrease in lung function, especially in patients with chronic obstructive pulmonary disease. Ozone frequently caused respiratory symptoms during exercise. Women showed decreased exercise performance and higher symptom prevalence than men during TRAP exposure. However, performance was analyzed in few studies. To date, research has not identified reliable biomarkers of TRAP-related lung damage useful for monitoring athletes' health, except in scarce studies on airway cells obtained by induced sputum or bronchoalveolar lavage. In conclusion, despite partly counteracted by the positive effects of habitual exercise, the negative effects of TRAP exposure to pollutants during exercise are hard to assess: outdoor exercise is a complex model, for multiple and variable exposures to air pollutants and pollutant concentrations. Further studies are needed to identify pollutant and/or time thresholds for performing safe outdoor exercise in cities.

Associations of long-term exposure to ambient fine particulate matter and nitrogen dioxide with lung function: A cross-sectional study in China

BACKGROUND

Few studies have evaluated the effects of ambient air pollution exposure on lung function, especially in areas with high air pollution levels.

OBJECTIVES

To investigate the associations of annual concentrations of particulate matter with diameters < 2.5 μm (PM_2.5) and nitrogen dioxide (NO₂) with adult lung function in Shanghai, China.

METHODS

We included 5276 permanent residents aged ≥ 20 years. Annual residential exposure to PM_2.5 and NO₂ was estimated by validated satellite-based and land use regression models, respectively. The effects of PM_2.5 and NO₂ on lung function were estimated separately using multivariable linear regression, adjusting for potential confounders.

RESULTS

Higher exposure to PM_2.5 and NO₂ was significantly associated with lower forced vital capacity (FVC), inspiration capacity (IC), and vital capacity (VC). An increase of 10 μg/m³ in the annual average PM_2.5 exposure was associated with a 45.83 ml (95% CI: -82.59, -9.07) lower FVC, 1.36 (95% CI: -2.42, -0.29) lower FVC of % predicted (FVC_%pred), 121.98 ml (95% CI: -164.38, -79.57) lower IC, and 89.12 ml (95% CI -124.94, -53.3) lower VC. For NO₂, an increase of 10 μg/m³ in the annual average concentration was associated with 26.65 ml (95% CI: -46.29, -7.00) lower FVC, 0.70 (95% CI: -1.27, 0.13) lower FVC_%pred, 65.26 ml (95% CI: -87.76, -42.76) lower IC, and 45.88 ml (95% CI: -65.03, -26.73) lower VC. The estimated effects on FEV1 were -10.25 ml (95% CI: -40.92, 20.42) and -0.29% (95% CI: -1.40, 0.82) per 10 μg/m³ increase in PM_2.5 and -0.74 ml (95% CI: -17.13, 15.65) and 0.01% (95% CI: -0.58, 0.61) per 10 μg/m³ increase in NO₂, which were not statistically significant. Stratified analysis showed that the estimated effects of PM_2.5 were greater in the healthy subgroup than the COPD patients. Obese individuals were more susceptible to adverse effects of PM_2.5 and NO₂ on lung function. Education level showed no or only weak evidence of modification of the associations between air pollution and lung function.

CONCLUSION

In this study, long-term exposure to ambient air pollutants was significantly associated with impaired lung function, presenting as restrictive ventilatory patterns.

Relationship between inter-city air pollution levels and physical fitness parameters among sixth-grade Mongolian primary school boys, China, 2013–2016

Objectives

Adverse health effects due to air pollution have recently been recognized as a serious social problem in China. In this study, we investigated inter-city relationships between air pollution and physical fitness levels among Mongolian elementary school boys in five cities of the Inner Mongolia Autonomous Region (IMAR), China.

Study design

Retrospective cross-sectional cohort study.

Methods

Physical fitness measurements of 1443 male Mongolian sixth-grade children were obtained from an existing dataset from the year 2013–2016, and correlations were calculated between these measurements and the percentage of good air quality days for five different cities: Hohhot, Baotou, Chifeng, Bayannur, and Xilinhot.

Results

Significant differences in the percentage of good air quality days from 2013 to 2016 were observed among the five cities studied. Statistical analysis showed a significantly positive correlation between good days and students’ vital capacity, and a significantly negative correlation between good days and 50 ​m ​× ​8 shuttle run time for the students included in this study. Differences in the extent of air pollution among the study cities might account for differences in lung function and cardiovascular endurance levels in these Mongolian children.

Conclusions

There is an urgent need for policy intervention to reduce air pollution levels in the IMAR. It is necessary to improve school physical education classes and physical training considering the current air pollution situation. Future research needs to replicate school year survey results from other cities, include longitudinal studies, and clarify the relationship between air pollution, physical exercise, and overall health.

•

Inter-city relationship between air pollution and physical fitness.

•

Policy intervention to reduce air pollution in the Inner Mongolia Autonomous Region.

•

Need to improve school physical education training due to current air pollution.

Air Pollution-Induced Autonomic Modulation

Air pollutants pose a serious worldwide health hazard, causing respiratory and cardiovascular morbidity and mortality. Pollutants perturb the autonomic nervous system, whose function is critical to cardiopulmonary homeostasis. Recent studies suggest that pollutants can stimulate defensive sensory nerves within the cardiopulmonary system, thus providing a possible mechanism for pollutant-induced autonomic dysfunction. A better understanding of the mechanisms involved would likely improve the management and treatment of pollution-related disease.

Associations of long-term exposure to ambient air pollution with cardiac conduction abnormalities in Chinese adults: The CHCN-BTH cohort study

BACKGROUND

Evidence regarding the effects of long-term and high-level ambient air pollution exposure on cardiac conduction systems remains sparse.

OBJECTIVES

To investigate the associations of long-term exposure to air pollution and cardiac conduction abnormalities in Chinese adults and explore the susceptibility characteristics.

METHODS

In 2017, a total of 27,047 participants aged 18-80 years were recruited from the baseline survey of the Cohort Study on Chronic Disease of Communities Natural Population in Beijing, Tianjin and Hebei (CHCN-BTH). The three year (2014-2016) average pollutant concentrations were assessed by a spatial statistical model for PM_2.5 and air monitoring stations for PM₁₀, SO₂, NO₂, O₃ and CO. Residential proximity to a roadway was calculated by neighborhood analysis. Associations were estimated by two-level generalized linear mixed models. Stratified analyses related to demographic characteristics, health behaviors, and cardiometabolic risk factors were performed. Two-pollutant models were used to evaluate the possible role of single pollutants.

RESULTS

We detected significant associations of long-term air pollutant exposure with increased heart rate (HR), QRS and QTc, such that an interquartile range increase in PM_2.5 was associated with 3.63% (95% CI: 3.07%, 4.19%), 1.21% (95% CI: 0.83%, 1.60%), and 0.13% (95% CI: 0.07%, 0.18%) changes in HR, QRS and QTc, respectively. Compared to the other pollutants, the estimates of PM_2.5 remained the most stable across all two-pollutant models. Similarly, significant associations were observed between living closer to a major roadway and higher HR, QRS and QTc. Stratified analyses showed generally greater association estimates in older people, males, smokers, alcohol drinkers, and those with obesity, hypertension and diabetes.

CONCLUSIONS

Long-term exposure to ambient air pollution was associated with cardiac conduction abnormalities in Chinese adults, especially in older people, males, smokers, alcohol drinkers, and those with cardiometabolic risk factors. PM_2.5 may be the most stable pollutant to reflect the associations.

Independent and Opposing Associations of Habitual Exercise and Chronic PM2.5 Exposures on Hypertension Incidence

BACKGROUND

We investigated the joint associations of habitual physical activity (PA) and long-term exposure to fine particulate matter (PM_2.5) with the development of hypertension in a longitudinal cohort in Taiwan.

METHODS

We selected 140 072 adults (≥18 years of age) without hypertension who joined a standard medical screening program with 360 905 medical examinations between 2001 and 2016. PM_2.5 exposure was estimated at each participant's address using a satellite data-based spatiotemporal model with 1 km² resolution. Information on habitual PA and a wide range of covariates was collected using a standard self-administered questionnaire. We used the Cox regression model with time-dependent covariates to examine the joint associations.

RESULTS

The mean age of all observations was 41.7 years, and 48.8% were male. The mean value for systolic and diastolic blood pressure was 112.5 and 68.7mm Hg, respectively. Approximately 34.2% of all observations were inactive (0 metabolic equivalence values-hours), 29.8% had moderate-PA (median [interquartile range]; 3.75 [3.38 to 4.38] metabolic equivalence values-hours), and 36.0% had high-PA (15.7 [10.3 to 24.8] metabolic equivalence values-hours). The mean±SD of PM_2.5 was 26.1±7.3 μg/m³. The prevalence of cardiovascular disease, diabetes mellitus, and cancer was 2.1%, 2.9%, and 1.5%, respectively. After adjusting for a wide range of covariates (including a mutual adjustment for PA or PM_2.5), a higher PA level was associated with a lower risk of hypertension (hazard ratio [HR] for the moderate- and high-PA was 0.93 [95% CI, 0.89-0.97] and 0.92 [95% CI, 0.88-0.96], respectively, as compared with the inactive-PA), whereas a higher level of PM_2.5 was associated with a higher risk of hypertension (HR for the moderate- and high-PM_2.5 was 1.37 [95% CI, 1.32-1.43] and 1.92 [95% CI, 1.81-2.04], respectively, as compared with the low-PM_2.5 group]. No significant interaction was observed between PA and PM_2.5 (HR 1.01 [95% CI, 1.00-1.02]).

CONCLUSIONS

A high-PA and low PM_2.5 exposure were associated with a lower risk of hypertension. The negative association between PA and hypertension remained stable in people exposed to various levels of PM_2.5, and the positive association between PM_2.5 and hypertension was not modified by PA. Our results indicated that PA is a suitable hypertension prevention strategy for people residing in relatively polluted regions.

Micronutrient-rich dietary intake is associated with a reduction in the effects of particulate matter on blood pressure among electronic waste recyclers at Agbogbloshie, Ghana

BACKGROUND

Informal recycling of electronic waste (e-waste) releases particulate matter (PM) into the ambient air. Human exposure to PM has been reported to induce adverse effects on cardiovascular health. However, the impact of PM on the cardiovascular health of e-waste recyclers in Ghana has not been studied. Although intake of micronutrient-rich diet is known to modify these PM-induced adverse health effects, no data are available on the relationship between micronutrient status of e-waste recyclers and the reported high-level exposure to PM. We therefore investigated whether the intake of micronutrient-rich diets ameliorates the adverse effects of ambient exposure to PM2.5 on blood pressure (BP).

METHODS

This study was conducted among e-waste and non-e-waste recyclers from March 2017 to October 2018. Dietary micronutrient (Fe, Ca, Mg, Se, Zn, and Cu) intake was assessed using a 2-day 24-h recall. Breathing zone PM2.5 was measured with a real-time monitor. Cardiovascular indices such as systolic BP (SBP), diastolic BP (DBP), and pulse pressure (PP) were measured using a sphygmomanometer. Ordinary least-squares regression models were used to estimate the joint effects of ambient exposure to PM2.5 and dietary micronutrient intake on cardiovascular health outcomes.

RESULTS

Fe was consumed in adequate quantities, while Ca, Se, Zn, Mg, and Cu were inadequately consumed among e-waste and non-e-waste recyclers. Dietary Ca, and Fe intake was associated with reduced SBP and PP of e-waste recyclers. Although PM2.5 levels were higher in e-waste recyclers, exposures in the control group also exceeded the WHO 24-h guideline value (25 μg/m3). Exposure to 1 μg/m3 of PM2.5 was associated with an increased heart rate (HR) among e-waste recyclers. Dietary Fe intake was associated with a reduction in systolic blood pressure levels of e-waste recyclers after PM exposure.

CONCLUSIONS

Consistent adequate dietary Fe intake was associated with reduced effects of PM2.5 on SBP of e-waste recyclers overtime. Nonetheless, given that all other micronutrients are necessary in ameliorating the adverse effects of PM on cardiovascular health, nutrition-related policy dialogues are required. Such initiatives would help educate informal e-waste recyclers and the general population on specific nutrients of concern and their impact on the exposure to ambient air pollutants.

Does fine particulate matter (PM2.5) affect the benefits of habitual physical activity on lung function in adults: a longitudinal cohort study

BACKGROUND

Physical activity (PA) increases a person's inhalation of air pollutants due to greater ventilation, possibly leading to larger adverse health effects. This study aims to investigate the combined effects of long-term exposure to fine particulate matter (PM_2.5) and habitual PA on lung function in adults.

METHODS

This was a longitudinal cohort study that included 278,065 Taiwan residents with an age of 20 years old or above who joined a standard medical screening programme between 2001 and 2014. Each participant received at least one medical examination (including spirometric, blood, and urinary tests and a standard self-administered questionnaire survey) during the study period. We estimated the 2-year average PM_2.5 concentrations at each participant's address using a new physical model based on observational data. Information on the participants' PA was collected using the standard self-administrated questionnaire. Generalised linear mixed models were used to investigate the combined effects of PM_2.5 and PA on pulmonary function. We also performed stratified analyses by different levels of PM_2.5 exposure and habitual PA.

RESULTS

Each 10 MET-h increase in PA was associated with a higher level of 0.20%, 0.16%, and 0.19% in forced vital capacity (FVC), forced expiratory volume in the first second (FEV₁), and maximum mid-expiratory flow (MMEF), respectively, after adjusting for PM_2.5 exposure and a wide range of covariates including age, sex education, body mass index, lifestyles, and health conditions. Each 10 μg/m³ increase in PM_2.5 was associated with a lower FVC, FEV₁, and MMEF (2.43%, 2.78% and 3.10%, respectively). Negative interactions were observed, and PM_2.5 exposure was associated with a greater reduction in lung function among the participants with higher PA levels.

CONCLUSIONS

We found significant negative interaction effects between long-term exposure to PM_2.5 and habitual PA, suggesting that the increased intake of PM_2.5 due to PA may attenuate the benefits of habitual PA on lung function. However, the PA benefits generally remained stable at different stratum of PM_2.5 in the stratified analyses, and habitual PA may still be recommended to people residing in relatively polluted regions.

Short time exposure to ambient ozone and associated cardiovascular effects: A panel study of healthy young adults

The evidence that exposure to ambient ozone (O₃) causes acute cardiovascular effects appears inconsistent. A repeated-measure study with 61 healthy young volunteers was conducted in Xinxiang, Central China. Real-time concentrations of O₃ were monitored. Cardiovascular outcomes including blood pressure (BP), heart rate (HR), serum levels of high sensitivity C-reactive protein (hs-CRP), 8-hydroxy-2'-deoxyguanosine (8-OHdG), tissue-type plasminogen activator (t-PA), and platelet-monocyte aggregation (PMA) were repeated measured. Linear mixed-effect models were used to analyze the association of ambient O₃ with these cardiovascular outcomes. Additionally, the modifying effects of glutathione S-transferase mu 1 (GSTM1) and glutathione S-transferase theta 1 (GSTT1) polymorphisms were estimated to explore the potential mechanisms and role of the association between O₃ exposure and the above cardiovascular outcomes. A 10 μg/m³ increase in O₃ was associated with increases of 9.2 mmHg (95% confidence interval [CI]: 2.5, 15.9), 7.2 mmHg (95% CI: 0.8, 13.6), and 21.2 bpm (95% CI: 5.8, 36.6) in diastolic BP (DBP, lag1), mean arterial BP (MABP, lag1), and HR (lag01), respectively. Meanwhile, the serum concentrations of hs-CRP, 8-OHdG, and t-PA were all increased by O₃ exposure, but the PMA level was decreased. Stratification analyses showed that the estimated effects of O₃ on DBP, MABP, and HR in GSTM1-sufficient subjects were significantly higher than in GSTM1-null subjects. Moreover, GSTM1-null genotype enhanced O₃-induced increases, albeit insignificant, in levels of serum hs-CRP, 8-OHdG, and t-PA compared with GSTM1-sufficient genotype. Insignificant increases in hs-CRP and t-PA were also detected in GSTT1-null subjects. Taken together, our findings indicate that acute exposure to ambient O₃ induces autonomic alterations, systemic inflammation, oxidative stress, and fibrinolysis in healthy young subjects. GSTM1 genotype presents the trend of modifying O₃-induced cardiovascular effects.

Health Impact Assessment (HIA) of a fluvial environment recovery project in a medium-sized Spanish town

INTRODUCTION

The Interdepartamental Public Health Plan of Catalonia (2014) seeks to enforce Health in All Policies (HiAP) at the regional and local levels. Within this context, the City Council of Sant Andreu de la Barca (SAB), the Metropolitan Area of Barcelona (MAB), and the Public Health Agency of Catalonia started a Health Impact Assessment (HIA) of an urbanistic redesign of the Llobregat fluvial area in SAB, the results of which are presented in this paper.

METHODOLOGY

In 2018, after a HIA screening, a prospective nonquantitative HIA was conducted. Politicians, professionals, and citizens participated in identifying potential impacts. Impacts were prioritized and linked to health determinants, scientific evidence, and potentially affected social groups. Afterwards, recommendations were formulated in order to improve the health impacts of the project. Finally, indicators were selected to evaluate HIA implementation.

RESULTS

The HIA was successfully implemented with the participation of technicians and citizens of SAB. The health impacts identified were mainly related to environmental, public safety, lifestyle, socioeconomic, and political contexts. Ten recommendations were defined to minimize the potential negative health impacts of the project, with six of them directly included and only one dismissed due to incompatibility.

CONCLUSION

A HIA was successfully carried out in the medium-sized town of Catalonia, promoting Health in all Policies at a local level and improving health impacts of an urbanistic project.

Statistical spatial-temporal modeling of ambient ozone exposure for environmental epidemiology studies: A review

BACKGROUND

Studies have discovered the adverse health impacts of ambient ozone. Most epidemiological studies explore the relationship between ambient ozone and health effects based on fixed site monitoring data. Fine modeling of ground-level ozone exposure conducted by statistical models has great advantages for improving exposure accuracy and reducing exposure bias. However, there is no review summarizing such studies.

OBJECTIVES

A review is presented to summarize the basic process of model development and to provide some suggestions for researchers.

METHODS

A search of PubMed, Web of Science and the Wanfang Database was performed for dates through July 1, 2019 to obtain relevant studies worldwide. We also examined the references of the articles of interest to ensure that as many articles as possible were included.

RESULTS

The land use regression model (LUR model), random forest model and artificial neural network model have been used in this field. We summarized these studies in terms of model selection, data preparation, simulation scale selection, and model establishment and validation. Multiparameters are a major feature of models. Parameters that influence the formation of ground-level ozone concentrations and parameters that have been extremely important in previous articles should be considered first. The process of model establishment and validation is essentially a process of continuously optimizing the model performance, but there are certain differences in the specific models.

CONCLUSION

This review summarized the basic process of the statistical model for ambient ozone exposure. We gave the applicable conditions and application scope of different models and summarized the advantages and disadvantages of various models in ozone modeling research. In the future, research is still needed to explore this area based on its own research purposes and capabilities.

Interactions between ambient air pollution and obesity on lung function in children: The Seven Northeastern Chinese Cities (SNEC) Study

Children are vulnerable to air pollution-induced lung function deficits, and the prevalence of obesity has been increasing in children. To evaluate the joint effects of long-term PM₁ (particulate matter with an aerodynamic diameter ≤ 1.0 μm) exposure and obesity on children's lung function, a cross-sectional sample of 6740 children (aged 7-14 years) was enrolled across seven northeastern Chinese cities from 2012 to 2013. Weight and lung function, including forced vital capacity (FVC), forced expiratory volume in 1 s (FEV₁), peak expiratory flow (PEF), and maximal mid-expiratory flow (MMEF), were measured according to standardized protocols. Average PM₁, PM_2.5, PM₁₀ and nitrogen dioxide (NO₂) exposure levels were estimated using a spatiotemporal model, and sulphur dioxide (SO₂) and ozone (O₃) exposure were estimated using data from municipal air monitoring stations. Two-level logistic regression and general linear models were used to analyze the joint effects of body mass index (BMI) and air pollutants. The results showed that long-term air pollution exposure was associated with lung function impairment and there were significant interactions with BMI. Associations were stronger among obese and overweight than normal weight participants (the adjusted odds ratios (95% confidence intervals) for PM₁ and lung function impairments in three increasing BMI categories were 1.50 (1.07-2.11) to 2.55 (1.59-4.07) for FVC < 85% predicted, 1.44 (1.03-2.01) to 2.51 (1.53-4.11) for FEV₁ < 85% predicted, 1.34 (0.97-1.84) to 2.04 (1.24-3.35) for PEF < 75% predicted, and 1.34 (1.01-1.78) to 1.93 (1.26-2.95) for MMEF < 75% predicted). Consistent results were detected in linear regression models for PM₁, PM_2.5 and SO₂ on FVC and FEV₁ impairments (P_Interaction < 0.05). These modification effects were stronger among females and older participants. These results can provide policy makers with more comprehensive information for to develop strategies for preventing air pollution induced children's lung function deficits among children.

Dynamic effect analysis of meteorological conditions on air pollution: A case study from Beijing

Air quality directly relates to human health and economic and social sustainable development. This study collected the meteorological data of Beijing from November 1, 2013 to October 31, 2017, employed vector autoregression (VAR) model, Granger causality test, impulse response function and variance decomposition to explore the dynamic effects of average humidity, extreme wind speed, sunshine duration, average wind speed and rainfall capacity on air quality index (AQI). The results indicated that the air pollution in Beijing was mainly a self-aggregation and self-diffusion process, the self-cumulative effect accounted for around 88.9318% during 5 periods, once the diffusion conditions of air pollution worsen, air pollution would be formed within 3 days. Meteorological conditions, especially extreme wind speed, sunshine duration and average humidity affected the concentration and spatial-temporal distribution of air pollutant. Extreme wind speed as atmospheric dynamic factor rather than average wind speed was the most important meteorological element influencing the AQI change in Beijing, which caused more atmospheric motion and turbulence, improving the diffusion and dilution ability of air pollutant, whose self-cumulative influence was around 7.5270% during 5 periods. Sunshine duration as atmospheric thermal factor was the secondary important meteorological element affecting AQI change in Beijing for it was associated with the formation of temperature stratification and inversion, the self-cumulative effect accounted for around 2.1402% during 4 periods. This study deepens the insights about the formation and diffusion mechanism of air pollution in Beijing, introduces nontraditional methods to review traditional issue and draw valuable conclusions. Other natural or human action factor should be further analyzed in the future research.

A New Integrative Theory of Brain-Body-Ecosystem Medicine: From the Hippocratic Holistic View of Medicine to Our Modern Society

Humans are increasingly aware that their fate will depend on the wisdom they apply in interacting with the ecosystem. Its health is defined as the condition in which the ecosystem can deliver and continuously renew its fundamental services. A healthy ecosystem allows optimal interactions between humans and the other biotic/abiotic components, and only in a healthy ecosystem can humans survive and efficiently reproduce. Thus, both the human and ecosystem health should be considered together in view of their interdependence. The present article suggests that this relationship could be considered starting from the Hippocrates (460 BC-370 BC) work "On Airs, Waters, and Places" to derive useful medical and philosophical implications for medicine which is indeed a topic that involves scientific as well as philosophical concepts that implicate a background broader than the human body. The brain-body-ecosystem medicine is proposed as a new more complete approach to safeguarding human health. Epidemiological data demonstrate that exploitation of the environment resulting in ecosystem damage affects human health and in several instances these diseases can be detected by modifications in the heart-brain interactions that can be diagnosed through the analysis of changes in heart rate variability.

Near-ground effect of height on pollen exposure

The effect of height on pollen concentration is not well documented and little is known about the near-ground vertical profile of airborne pollen. This is important as most measuring stations are on roofs, but patient exposure is at ground level. Our study used a big data approach to estimate the near-ground vertical profile of pollen concentrations based on a global study of paired stations located at different heights. We analyzed paired sampling stations located at different heights between 1.5 and 50 m above ground level (AGL). This provided pollen data from 59 Hirst-type volumetric traps from 25 different areas, mainly in Europe, but also covering North America and Australia, resulting in about 2,000,000 daily pollen concentrations analyzed. The daily ratio of the amounts of pollen from different heights per location was used, and the values of the lower station were divided by the higher station. The lower station of paired traps recorded more pollen than the higher trap. However, while the effect of height on pollen concentration was clear, it was also limited (average ratio 1.3, range 0.7-2.2). The standard deviation of the pollen ratio was highly variable when the lower station was located close to the ground level (below 10 m AGL). We show that pollen concentrations measured at >10 m are representative for background near-ground levels.

On the interpretation of bioaerosol exposure measurements and impacts on health

Bioaerosols are recognized as one of the main transmission routes for infectious diseases and are responsible for other various types of health effects through inhalation and potential ingestion. Associating exposure with bioaerosol and health problems is challenging, and adequate exposure monitoring is a top priority for aerosol scientists. The multiple factors affecting bioaerosol content, the variability in the focus of each bioaerosol exposure study, and the variations in experimental design and the standardization of methods make bioaerosol exposure studies very difficult. Therefore, the health impacts of bioaerosol exposure are still poorly understood. This paper presents a brief description of a state-of-the-art development in bioaerosol exposure studies supported by studies on several related subjects. The main objective of this paper is to propose new considerations for bioaerosol exposure guidelines and the development of tools and study designs to better interpret bioaerosol data. The principal observations and findings are the discrepancy of the applicable methods in bioaerosol studies that makes result comparison impossible. Furthermore, the silo mentality helps in creating a bigger gap in the knowledge accumulated about bioaerosol exposure. Innovative and original ideas are presented for aerosol scientists and health scientists to consider and discuss. Although many examples cited herein are from occupational exposure, the discussion has relevance to any human environment. This work gives concrete suggestions for how to design a full bioaerosol study that includes all of the key elements necessary to help understand the real impacts of bioaerosol exposure in the short term. The creation of the proposed bioaerosol public database could give crucial information to control the public health. Implications: How can we move toward a bioaerosol exposure guidelines? The creation of the bioaerosol public database will help accumulate information for long-term association studies and help determine specific exposure biomarkers to bioaerosols. The implementation of such work will lead to a deeper understanding and more efficient utilization of bioaerosol studies to prevent public health hazards.

Causal Modeling in Environmental Health

The field of environmental health has been dominated by modeling associations, especially by regressing an observed outcome on a linear or nonlinear function of observed covariates. Readers interested in advances in policies for improving environmental health are, however, expecting to be informed about health effects resulting from, or more explicitly caused by, environmental exposures. The quantification of health impacts resulting from the removal of environmental exposures involves causal statements. Therefore, when possible, causal inference frameworks should be considered for analyzing the effects of environmental exposures on health outcomes.

Acute Effects of Air Pollution and Noise from Road Traffic in a Panel of Young Healthy Adults

Panel studies are an efficient means to assess short-term effects of air pollution and other time-varying environmental exposures. Repeated examinations of volunteers allow for an in-depth analysis of physiological responses supporting the biological interpretation of environmental impacts. Twenty-four healthy students walked for 1 h at a minimum of four separate occasions under each of the following four settings: along a busy road, along a busy road wearing ear plugs, in a park, and in a park but exposed to traffic noise (65 dB) through headphones. Particle mass (PM_2.5, PM₁), particle number, and noise levels were measured throughout each walk. Lung function and exhaled nitrogen oxide (NO) were measured before, immediately after, 1 h after, and approximately 24 h after each walk. Blood pressure and heart rate variability were measured every 15 min during each walk. Recorded air pollution levels were found to correlate with reduced lung function. The effects were clearly significant for end-expiratory flows and remained visible up to 24 h after exposure. While immediate increases in airway resistance could be interpreted as protective (muscular) responses to particulate air pollution, the persisting effects indicate an induced inflammatory reaction. Noise levels reduced systolic blood pressure and heart rate variability. Maybe due to the small sample size, no effects were visible per specific setting (road vs. park).

The pulmonary and autonomic effects of high-intensity and low-intensity exercise in diesel exhaust

BACKGROUND

Exposure to air pollution impairs aspects of pulmonary and autonomic function and causes pulmonary inflammation. However, how exercising in air pollution affects these indices is poorly understood. Therefore, the purpose of this study was to determine the effects of low-intensity and high-intensity cycling with diesel exhaust (DE) exposure on pulmonary function, heart rate variability (HRV), fraction of exhaled nitric oxide (FeNO), norepinephrine and symptoms.

METHODS

Eighteen males performed 30-min trials of low-intensity or high-intensity cycling (30 and 60% of power at VO_2peak) or a resting control condition. For each subject, each trial was performed once breathing filtered air (FA) and once breathing DE (300μg/m³ of PM_2.5, six trials in total). Pulmonary function, FeNO, HRV, norepinephrine and symptoms were measured prior to, immediately post, 1 h and 2 h post-exposure. Data were analyzed using repeated-measures ANOVA.

RESULTS

Throat and chest symptoms were significantly greater immediately following DE exposure than following FA (p < 0.05). FeNO significantly increased 1 h following high-intensity exercise in DE (21.9 (2.4) vs. 19.3 (2.2) ppb) and FA (22.7 (1.7) vs. 19.9 (1.4)); however, there were no differences between the exposure conditions. All HRV indices significantly decreased following high-intensity exercise (p < 0.05) in DE and FA. The exception to this pattern was LF (nu) and LF/HF ratio, which significantly increased following high-intensity exercise (p < 0.05). Plasma norepinephrine (NE) significantly increased following high-intensity exercise in DE and FA, and this increase was greater than following rest and low-intensity exercise (p < 0.05). DE exposure did not modify any effects of exercise intensity on HRV or norepinephrine.

CONCLUSIONS

Healthy individuals may not experience greater acute pulmonary and autonomic effects from exercising in DE compared to FA; therefore, it is unclear if such individuals will benefit from reducing vigorous activity on days with high concentrations on particulate matter.

Long-term exposure to fine particulate matter and tachycardia and heart rate: Results from 10 million reproductive-age adults in China

BACKGROUND

Epidemiological evidence of the association of long-term ambient fine particulate matter (aerodynamic diameter ≤2.5 μm; PM_2.5) exposure with resting heart rate is limited. We explored the association of long-term (3-year average) ambient PM_2.5 exposure with tachycardia and resting heart rate.

METHODS

This cross-sectional study surveyed 10,427,948 reproductive-age (20-49 years) adults across China in 2015. Tachycardia was classified as a resting heart rate of >80 beats per minute (bpm). The annual average ambient PM_2.5 concentrations were obtained from a hybrid satellite-based geophysical statistical model. Linear mixed models and mixed effects logistic regressions adjusted for potential confounding were performed to explore the associations of PM_2.5 with resting heart rate and PM_2.5 with tachycardia, respectively. The effect modifiers by sex, age, body mass index, urbanity, race, region, smoking status, and drinking status were also assessed. Attributable cases and population fraction were estimated according to the PM_2.5- tachycardia relationship.

RESULTS

The mean age was 28 years, and 16.3% of the participants had tachycardia. The odds ratio for tachycardia was 1.018 (95% confidence intervals [CI]: 1.017, 1.020) per 10 μg/m³ increase in the 3-year average PM_2.5 exposure. A 10 μg/m³ increase in the 3-year average ambient PM_2.5 level was associated with a 0.076 (95% CI: 0.073, 0.079) bpm elevation in the resting heart rate. Of the tachycardia burden, 4.0% (95% CI: 3.8%, 4.3%) could be attributed to ambient PM_2.5 exposure in Chinese reproductive-age adults.

CONCLUSIONS

Exposures to ambient PM_2.5 were associated with elevated resting heart rate. It might be possible to decrease China's avoidable tachycardia burden in reproductive-age adults through decreasing PM_2.5 levels.