Diesel exhaust exposure among adolescents in Harlem: a community-driven study

Biomarkers of exposure in environment-wide association studies - Opportunities to decode the exposome using human biomonitoring data

BACKGROUND

The European Union's 7th Framework Programme (EU's FP7) project HEALS - Health and Environment-wide Associations based on Large Population Surveys - aims a refinement of the methodology to elucidate the human exposome. Human biomonitoring (HBM) provides a valuable tool for understanding the magnitude of human exposure from all pathways and sources. However, availability of specific biomarkers of exposure (BoE) is limited.

OBJECTIVES

The objective was to summarize the availability of BoEs for a broad range of environmental stressors and exposure determinants and corresponding reference and exposure limit values and biomonitoring equivalents useful for unraveling the exposome using the framework of environment-wide association studies (EWAS).

METHODS

In a face-to-face group discussion, scope, content, and structure of the HEALS deliverable "Guidelines for appropriate BoE selection for EWAS studies" were determined. An expert-driven, distributed, narrative review process involving around 30 individuals of the HEALS consortium made it possible to include extensive information targeted towards the specific characteristics of various environmental stressors and exposure determinants. From the resulting 265 page report, targeted information about BoE, corresponding reference values (e.g., 95th percentile or measures of central tendency), exposure limit values (e.g., the German HBM I and II values) and biomonitoring equivalents (BEs) were summarized and updated.

RESULTS

64 individual biological, chemical, physical, psychological and social environmental stressors or exposure determinants were included to fulfil the requirements of EWAS. The list of available BoEs is extensive with a number of 135; however, 12 of the stressors and exposure determinants considered do not leave any measurable specific substance in accessible body specimens. Opportunities to estimate the internal exposure stressors not (yet) detectable in human specimens were discussed.

CONCLUSIONS

Data about internal exposures are useful to decode the exposome. The paper provides extensive information for EWAS. Information included serves as a guideline - snapshot in time without any claim to comprehensiveness - to interpret HBM data and offers opportunities to collect information about the internal exposure of stressors if no specific BoE is available.

Urinary polycyclic aromatic hydrocarbons and measures of oxidative stress, inflammation and renal function in adolescents: NHANES 2003-2008

OBJECTIVE

Recent evidence has suggested that polycyclic aromatic hydrocarbons (PAHs) may contribute to cardiometabolic and kidney dysfunction by increasing oxidative stress, but little is known about impacts in childhood.

STUDY DESIGN

We performed cross-sectional analyses of 660 adolescents aged 12-19 years in the 2003-2008 National Health and Nutrition Examination Survey (NHANES), using levels of 10 monohydroxylated urinary PAH metabolites as our exposure. Our primary outcomes of interest were biomarkers of oxidative stress and renal function, including estimated glomerular filtration rate (eGFR), urinary albumin to creatinine ratio (ACR), insulin resistance, and serum uric acid, gamma glutamyl transferase (GGT) and C-reactive protein (CRP).

RESULTS

We observed statistically significant associations between PAH metabolites and levels of serum GGT, CRP, uric acid and eGFR. Each 100% increase in 2-hydroxyphenanthrene was related to a 3.36% increase in uric acid (95% CI: 0.338-6.372; p=0.032), a 3.86% increase in GGT (95% CI: 1.361-6.362; p=0.005) and a 16.78% increase in CRP (95% CI: 1.848-31.689; p=0.029). Each 100% increase in 4-hydroxyphenanthrene was associated with a 6.18% increase in GGT (95% CI: 4.064-8.301; p<0.001) and a 13.66% increase in CRP (95% CI: 2.764-24.564; p=0.017). Each 100% increase in 9-hydroxyfluorene was associated with a 2.58% increase in GGT (95% CI: 0.389-4776; p=0.024). Each 100% increase in 3-hydroxyphenanthrene was associated with a 2.66% decrease in eGFR (95% CI: -4.979 to -0.331; p=0.028).

CONCLUSIONS

Urinary PAH metabolites were associated with serum uric acid, GGT and CRP, suggesting possible impacts on cardiometabolic and kidney function in adolescents. Prospective work is needed to investigate the potential long-term health consequences of these findings.

Analyzing the Relationship Between Bus Pollution Policies and Morbidity Using a Quasi-Experiment

Transit buses are used by millions of commuters every day, but they emit toxic diesel fumes. In 1988, the U.S. Environmental Protection Agency implemented emission standards for transit buses, which have been continually updated. Yet there is no quantitative evidence of the health benefits from these bus pollution policies due to data constraints and confounding variables. In this study, a quasi-experiment is used to exploit the geographic and temporal variation in emission standards by using bus vintage as a proxy for bus emissions. This is accomplished using a unique, rich panel data set, which includes daily information on bus vintage and route for the New York City Transit bus fleet between 2006 and 2009. This information is merged with daily data on emergency department (ED) visits for respiratory illnesses, which include patients' residences at the census block level and exact admission date. Economic benefits resulting from these bus pollution policies are then estimated. Results show that stricter transit bus emission standards by the U.S. Environmental Protection Agency for particulate matter are associated with reduced ED visits for respiratory diseases for patients living within a few hundred feet of a bus route. These findings demonstrate that bus pollution policies have made critical improvements to public health.

Building-related health symptoms and classroom indoor air quality: a survey of school teachers in New York State

Most previous research on indoor environments and health has studied school children or occupants in non-school settings. This investigation assessed building-related health symptoms and classroom characteristics via telephone survey of New York State school teachers. Participants were asked about 14 building-related symptoms and 23 classroom characteristics potentially related to poor indoor air quality (IAQ). Poisson regression analysis was used to assess the relationship between these symptoms and each classroom characteristic, controlling for potential confounders. About 500 teachers completed the survey. The most frequently reported classroom characteristics included open shelving (70.7%), food eaten in class (65.5%), dust (59.1%), and carpeting (46.9%). The most commonly reported symptoms included sinus problems (16.8%), headache (15.0%), allergies/congestion (14.8%), and throat irritation (14.6%). Experiencing one or more symptoms was associated most strongly with reported dust (relative risk (RR) = 3.67; 95% confidence interval (CI): 2.62-5.13), dust reservoirs (RR = 2.13; 95% CI: 1.72-2.65), paint odors (RR = 1.73; 95% CI: 1.40-2.13), mold (RR = 1.71; 95% CI: 1.39-2.11), and moldy odors (RR = 1.65 95% CI: 1.30-2.10). Stronger associations were found with increasing numbers of reported IAQ-related classroom characteristics. Similar results were found with having any building-related allergic/respiratory symptom. This research adds to the body of evidence underscoring the importance to occupant health of school IAQ.

PRACTICAL IMPLICATIONS

Teachers play an important role in educating children, and teacher well-being is important to this role. Health symptoms among New York teachers while at work are common and appear to be associated with numerous characteristics related to poor classroom IAQ. Improving school Indoor Air Quality may reduce sickness and absenteeism and improve teacher performance.

Using urinary biomarkers to evaluate polycyclic aromatic hydrocarbon exposure in 126 preschool children in Ohio

Limited data exist on exposures of young children to polycyclic aromatic hydrocarbons (PAHs) in the United States (US). The urinary metabolite of pyrene, 1-hydroxypyrene (1-OHPyr), is widely used as a biomarker of total PAH exposure. Our objectives were to quantify urinary 1-OHPyr levels in 126 preschool children over a 48-h period and to examine associations between selected sociodemographic/lifestyle factors and urinary 1-OHPyr levels. Monitoring was performed at 126 homes and 16 daycares in Ohio in 2001, and questionnaires and urine samples were collected. The median urinary 1-OHPyr level was 0.33 ng/mL. In a multiple regression model, sampling season (p = 0.0001) and natural log (ln)-transformed creatinine concentration (p = 0.0006) were highly significant predictors of ln-transformed 1-OH-Pyr concentration; cooking appliance type (p = 0.096) was a marginally significant predictor of ln(1-OHPyr). These children had higher median urinary 1-OHPyr levels compared to other US children (≤ 0.15 ng/mL) in previously published studies, which suggests possible geographical differences in PAH exposure.

Oxidative stress and aromatic hydrocarbon response of human bronchial epithelial cells exposed to petro- or biodiesel exhaust treated with a diesel particulate filter

The composition of diesel exhaust has changed over the past decade due to the increased use of alternative fuels, like biodiesel, and to new regulations on diesel engine emissions. Given the changing nature of diesel fuels and diesel exhaust emissions, a need exists to understand the human health implications of switching to "cleaner" diesel engines run with particulate filters and engines run on alternative fuels like biodiesel. We exposed well-differentiated normal human bronchial epithelial cells to fresh, complete exhaust from a diesel engine run (1) with and without a diesel particulate filter and (2) using either traditional petro- or alternative biodiesel. Despite the lowered emissions in filter-treated exhaust (a 91-96% reduction in mass), significant increases in transcripts associated with oxidative stress and polycyclic aromatic hydrocarbon response were observed in all exposure groups and were not significantly different between exposure groups. Our results suggest that biodiesel and filter-treated diesel exhaust elicits as great, or greater a cellular response as unfiltered, traditional petrodiesel exhaust in a representative model of the bronchial epithelium.

Risk assessment of inhalation exposure to polycyclic aromatic hydrocarbons in school children

Polycyclic aromatic hydrocarbons (PAHs) associated with the inhalable fraction of particulate matter were determined for 1 year (2009-2010) at a school site located in proximity of industrial and heavy traffic roads in Delhi, India. PM10 (aerodynamic diameter ≤10 μm) levels were ∼11.6 times the World Health Organization standard. Vehicular (59.5%) and coal combustion (40.5%) sources accounted for the high levels of PAHs (range 38.1-217.3 ng m(-3)) with four- and five-ring PAHs having ∼80 % contribution. Total PAHs were dominated by carcinogenic species (∼75%) and B[a]P equivalent concentrations indicated highest exposure risks during winter. Extremely high daily inhalation exposure of PAHs was observed during winter (439.43 ng day(-1)) followed by monsoon (232.59 ng day(-1)) and summer (171.08 ng day(-1)). Daily inhalation exposure of PAHs to school children during a day exhibited the trend school hours > commuting to school > resting period in all the seasons. Vehicular source contributions to daily PAH levels were significantly correlated (r = 0.94, p < 0.001) with the daily inhalation exposure level of school children. A conservative estimate of ∼11 excess cancer cases in children during childhood due to inhalation exposure of PAHs has been made for Delhi.

Emissions of particulate-bound elements from biodiesel and ultra low sulfur diesel: size distribution and risk assessment

Use of waste cooking oil derived biodiesel (WCOB) as an alternative fuel in diesel engines has increased significantly in recent years. The impact of WCOB on particulate emissions from diesel engines needs to be investigated thoroughly. This study was conducted to make a comparative evaluation and size-differentiated speciation of the particulate bound elements from ultra low sulfur diesel (ULSD) and WCOB and a blend of both of the fuels (B50). Particle mass and their elemental size distributions ranging from 0.01-5.6 μm were measured. It was observed that more ultrafine particles (UFPs, <100 nm) were emitted when the engine was fueled with WCOB. Fifteen particulate-bound elements such as K, Al, Mg, Co, Cr, Cu, Fe, Mn, Cd, Ni, As, Ba, Pb, Zn and Sr were investigated and reported in this study. Potential health risk associated with these particulate bound elements upon inhalation was also evaluated based on dose-response assessments for both adults and children. The findings indicate that the exposure to PM of the B100 exhaust is relatively more hazardous and may pose adverse health effects compared to that of ULSD. Also, investigations on human health risk due to exposure to UFPs indicate that UFPs contribute a major fraction (>70%) of the total estimated health risk.

Guidelines for writing manuscripts about community-based participatory research for peer-reviewed journals

Despite the importance of disseminating the results of community-based participatory research (CBPR), community health partnerships face many challenges in getting their work published. The purpose of this article is to present practical guides for writing about CBPR for those who have little experience in writing for publication or those who want to help their partners write strong manuscripts for peer-reviewed journals. The article includes tips on how to organize each part of a manuscript, suggestions on how partners can collaborate on preparing manuscripts, recommendations on how to convey unique aspects of a partnership's work throughout a manuscript, and an annotated bibliography of well-written CBPR articles. By understanding how to prepare a manuscript about CBPR for a peer-reviewed journal, authors should be more effective in disseminating information that will help other communities to benefit from their partnership's work.

Polycyclic aromatic hydrocarbon metabolite levels and pediatric allergy and asthma in an inner-city cohort

Exposure to polycyclic aromatic hydrocarbons (PAH) has been associated with allergic sensitization and asthma. We hypothesized that increased urinary PAH metabolites are associated with allergy or asthma among children age 5 yrs in an inner-city birth cohort. As part of an ongoing prospective birth cohort under the auspices of the Columbia Center for Children's Environmental Health (CCCEH), urine was collected from 5-yr-old children (n = 222) of Dominican American and African American mothers in Northern Manhattan and South Bronx of New York City. Twenty-four PAH metabolites were measured in these specimens, and their levels (unadjusted and specific gravity corrected) were evaluated with IgE levels and asthma outcomes. Ten metabolites were detected in urine from all children. Concentrations ranged higher than those in representative samples of US children ages 6-11 in the National Health and Nutrition Examination Survey (NHANES). Among CCCEH children, compared with African Americans, the Dominican children had higher 2-hydroxynaphthalene but lower 9-hydroxyfluorene and 4-hydroxyphenanthrene concentrations. Increased 3-hydroxyfluorene and 3-hydroxyphenanthrene levels were associated with higher anti-mouse IgE levels (p < 0.05). These plus 2-hydroxynaphthalene, 2-hydroxyflourene and 1-hydroxyphenanthrene concentrations were associated with higher anti-mouse IgE levels on multivariate analyzes. Increased 2-hydroxyphenanthrene, 3-hydroxyphenanthrene and 4-hydroxyphenanthrene levels were associated with higher anti-cat IgE levels (p < 0.05) in univariate, but not multivariate, analyzes. Levels of PAH metabolites were not associated with respiratory symptoms. Measures of PAH metabolites suggest considerable exposure in an urban pediatric population, and possible associations with allergic sensitization to mouse.

Serum polycyclic aromatic hydrocarbons among children with and without asthma: correlation to environmental and dietary factors

BACKGROUND

Children from low-income families may be subject to high exposures to polycyclic aromatic hydrocarbons (PAH) which can lead to respiratory disorders. This study aims to establish methods for assessing total PAH exposure of asthmatic and non-asthmatic children from low-income families; to estimate serum PAH concentrations of these children, and to estimate the relative importance of the environmental pathways for PAH exposure.

MATERIALS AND METHODS

A total of 75 (61 asthmatic, 14 non-asthmatic) Saudi children 15 years old and below were included to participate in this cross-sectional study. Each participant answered a generalized questionnaire with dietary questions. Serum PAH were measured using HPLC with UV detection.

RESULTS

Serum naphthalene and pyrene were significantly elevated among asthmatic children (p-values = 0.007 and 0.01, respectively). Serum acenaphthylene, fluorine and 1,2-benzanthracene, on the other hand, were significantly higher among non-asthmatics (p-values = 0.001, 0.04 and 0.03, respectively). There was a significant correlation between the presence of a smoker in the family and serum concentrations of carbazole, pyrene, 1,2-benzanthracene and benzacephenanthrylene (R = 0.37, 0.45, 0.43, 0.33; p-values = 0.01, 0.0002, 0.003 and 0.025, respectively). Significant correlations were elicited between daily meat intake and serum levels of acenaphthylene, benzopyrene and 1,2-benzanthracene (R = 0.27, 0.27, 0.33; p-values = 0.02 and < 0.001, respectively).

CONCLUSION

Among the children, serum PAH were significantly correlated to meat intake as well as presence of smokers at home. Public health awareness should be enhanced by educating parents to take certain precautions at home, such as preventing indoor smoking and reducing the intake of grilled and smoked meat by children so as to decrease their exposure to carcinogenic PAH.

Seasonal and regional contributors of 1-hydroxypyrene among children near a steel mill

Urinary 1-hydroxypyrene (1-OHP) is a biomarker of exposure to polycyclic aromatic hydrocarbons (PAH). Effect of residence on children's PAH exposure was reported among children living near a polluted area. Instead of a snapshot assessment, however, a temporal history of exposure characteristics needs to be assessed in the studies of chronic disease development such as cancer. The urinary 1-OHP measurements were repeated to determine regional effect of ambient air pollution on 1-OHP levels over extended periods. Two sites were chosen: (a) one site located near the steel mill ("nearby" site) and (b) the other site located at a longer distance from the mill ("remote" site). Spot urinary 1-OHP levels were measured from 72 children for 3 consecutive days per month, repeated over 9-month period. Compared with remote site, the nearby site had increased the urinary 1-OHP level by 62.3% [95% confidence interval (95% CI), 39.8-88.3%]. Other statistically significant factors that contributed to the level include sex [16.5% (95% CI, 1.2-34.1%) higher for girls than boys], consumption of charbroiled meat [16.5% (95% CI, 1.1-34.2%) higher], and an increase in PM(10) [10.1% (95% CI, 4.8-15.7%) higher for the interquartile range increment]. Controlling for covariates, the 1-OHP levels were increased in the summer and fall compared with winter. The magnitude of the effects of both seasons had diminished after adjusting for PM(10). This is the first report providing seasonal and regional contributors to environmental PAH exposure, assessed by urinary 1-OHP, with higher 1-OHP levels during summer when ambient pollution was also high.

Participant experiences in a breastmilk biomonitoring study: a qualitative assessment

BACKGROUND

Biomonitoring studies can provide information about individual and population-wide exposure. However they must be designed in a way that protects the rights and welfare of participants. This descriptive qualitative study was conducted as a follow-up to a breastmilk biomonitoring study. The primary objectives were to assess participants' experiences in the study, including the report-back of individual body burden results, and to determine if participation in the study negatively affected breastfeeding rates or duration.

METHODS

Participants of the Greater Boston PBDE Breastmilk Biomonitoring Study were contacted and asked about their experiences in the study: the impact of study recruitment materials on attitudes towards breastfeeding; if participants had wanted individual biomonitoring results; if the protocol by which individual results were distributed met participants' needs; and the impact of individual results on attitudes towards breastfeeding.

RESULTS

No participants reported reducing the duration of breastfeeding because of the biomonitoring study, but some responses suggested that breastmilk biomonitoring studies have the potential to raise anxieties about breastfeeding. Almost all participants wished to obtain individual results. Although several reported some concern about individual body burden, none reported reducing the duration of breastfeeding because of biomonitoring results. The study literature and report-back method were found to mitigate potential negative impacts.

CONCLUSION

Biomonitoring study design, including clear communication about the benefits of breastfeeding and the manner in which individual results are distributed, can prevent negative impacts of biomonitoring on breastfeeding. Adoption of more specific standards for biomonitoring studies and continued study of risk communication issues related to biomonitoring will help protect participants from harm.

Tangible evidence, trust and power: public perceptions of community environmental health studies

Communities with environmental health concerns in the USA frequently request studies from their local or state departments of public health. This paper presents findings from three focus groups conducted in communities north of Boston that have been the subject of two different environmental health studies. The focus groups were designed to elicit residents' perceptions of environmental health, and of the particular studies conducted in their communities. In all focus groups, participants had difficulty accepting the findings of health studies that contradicted their own experiences of environmental exposures and illness. Our results suggest that lay knowledge, informed in varying degrees by the experience of what we term "tangible evidence," creates a lens through which communities interpret a health study's findings. The differences in reliance on tangible evidence were related to participants' sense of trust in public officials, and the institutions responsible for conducting health studies. Participants from the wealthier, predominantly white communities discussed trust in study design and methodologies used. In contrast, participants from the lower-income, higher-minority communities assessed health studies with reference to their trust (or lack thereof) in study sponsors and public health institutions. Participants' experience of tangible evidence, trust or distrust in health agencies and research institutions, and a sense of relative community power, influence how they assess the findings of environmental health studies and may have implications for pubic health.

Community-based participatory research: a vehicle to promote public engagement for environmental health in China

BACKGROUND

In the past 25 years, China has experienced remarkable economic growth and rapid agricultural-to-industrial and rural-to-urban transitions. As a consequence, China now faces many daunting environmental challenges that are significantly affecting human health and quality of life, including indoor and outdoor air pollution, water pollution, deforestation, loss of agricultural land, and sustainability. Chinese government leaders have recently emphasized the need for better environmental protection practices along with interventions involving strong public participation.

OBJECTIVES

Community-based participatory research (CBPR) is a collaborative approach to research that involves community members, organizational representatives, and researchers as equal participants in all phases of the research process. Over the past 15 years, CBPR has gained recognition and acceptance and is now valued as a means to effect change and provide scientific knowledge relevant to human health and the environment. In this article we highlight the success of CBPR in the United States and suggest that it could be a useful model for addressing environmental health problems in the People's Republic of China.

DISCUSSION

CBPR can reduce the tension between science and society by promoting genuine communication, by enabling scientists and administrators to listen and respond to the public, by allowing communities to help shape the research agenda, and by increasing accountability of researchers and governments to the public.

CONCLUSIONS

CBPR can potentially help improve environmental health in China, but it is likely to take a different form than it has in the West because the government will be leading the way.

Integrating epidemiology, education, and organizing for environmental justice: community health effects of industrial hog operations

The environmental justice movement has stimulated community-driven research about the living and working conditions of people of color and low-income communities. We describe an epidemiological study designed to link research with community education and organizing for social justice. In eastern North Carolina, high-density industrial swine production occurs in communities of low-income people and people of color. We investigated relationships between the resulting pollution and the health and quality of life of the hog operations' neighbors. A repeat-measures longitudinal design, community involvement in data collection, and integration of qualitative and quantitative research methods helped promote data quality while providing opportunities for community education and organizing. Research could affect policy through its findings and its mobilization of communities.

Did a ban on diesel-fuel reduce emergency respiratory admissions for children?

This paper assesses whether a ban on diesel-powered motor vehicles in Lebanon has reduced emergency respiratory admissions for children less than 17 years of age in Beirut. Monthly admissions for total respiratory complaints, asthma, bronchitis, pneumonia, and upper respiratory tract infections, from October to February, were compared before and after the ban, using Poisson regression models and adjusting for rainfall, humidity and temperature. Analyses were repeated excluding the flu months of January and February. A test of significance of p < or = 0.05 was used. Air pollution is not systematically monitored in Lebanon and no ambient particulate concentration data were available. A significant drop in admissions for respiratory symptoms (p < or = 0.05) and upper respiratory tract infection (p < or = 0.001) from 1 year pre-ban to 1 year post-ban has been recorded. When flu months are excluded, a significant drop (p < or = 0.001) in admissions for all studied categories, except pneumonia, is observed. The effect of the ban however was negligible in the second year. When 2 year pre-ban versus 2 year post-ban are considered excluding flu months, statistically non-significant reductions are recorded for asthma and upper respiratory tract infection (p < or = 0.1). The study hence suggests an impact of the diesel ban on respiratory health only during the first year after the ban. This finding is weakened by the absence of supporting evidence from air quality monitoring and speciation of particulate matter, which are lacking in Lebanon and most developing countries.

Housing conditions and respiratory health in a Boston public housing community

OBJECTIVES

To determine frequency of and possible associations between environmental housing factors and self-reported respiratory symptoms in public housing.

METHODS

We used a community-participatory method in which trained residents conducted in-person interviews with a random sample of 53 households in one housing development in Boston, Massachusetts.

RESULTS

Environmental factors suspected of affecting respiratory health that were reported by more than 30 percent of respondents included: Moisture (43 percent), mold (43 percent), cracks in walls, floors and ceilings (49 percent), sewage leaks (33 percent), unexplained odor (35 percent), use of air fresheners (91 percent), use of gas ovens for heating (38 percent), no vent for the oven (74 percent), stuffy air (66 percent), overheating at least part of the winter (73 percent), cockroaches (70 percent), rodents (40 percent), pets (39 percent), frequent renovations (40 percent), repeated requests for repairs (52 percent), dust from construction (45 percent), use of more than three hazardous household products (32 percent), vehicle traffic nearby (81 percent), and smoking in the household (57 percent). Forty percent of respondents reported having asthma. Respondents also reported that 56 percent of their children had asthma. Forty percent of respondents reported wheeze and 48 percent reported coughing or sneezing episodes in the preceding month. We found the following positive statistically significant associations, adjusted for age, sex, Black or Hispanic origin, and years lived in public housing: wheeze with moisture problems (OR = 4.8; CI = 1.2, 19.3), sewage leaks (OR = 6.3; CI = 1.3, 30.3), odor (OR = 7.5; CI = 1 .4, 39.0), cracks in walls,floors and ceilings (OR = 8.6; CI 1.9, 38.0), and frequency of renovations (OR = 9.8; CI = 1.8, 54.4); cough with moisture problems (OR = 5.3; CI = 1.3, 20.8), stuffy air (OR = 4.4; CI = 1.2, 16.7), cockroaches (OR = 5.4; CI = 1.2, 24.2), smoking (OR = 5.0; CI = 1.2, 20.5), odor (OR = 10.9; CI = 2.3, 53.0), cracks in walls, floors and ceilings (OR = 6.2; CI = 1.8, 22.3) and frequency of renovations (OR = 4.4; CI = 1.1, 17.5); and sneeze with cockroaches (OR = 5.2; CI = 1.1, 24.2), stuffy air (OR = 6.3; CI = 1.5, 26.5), cracks in walls, floors and ceilings (OR = 6.3; CI = 1.7, 23.1), repeated requests for repairs (OR = 5.6; CI = 1.4, 21.5), and construction dust (OR = 15.6; CI = 2.2, 112.3).

CONCLUSIONS

Housing conditions that affect respiratory health were common in this public housing development. Self-reported rates of respiratory symptoms and asthma were extremely high. Statistical associations between housing conditions and respiratory symptoms in the preceding month were frequently positive and sometimes statistically significant. Engaging community residents strengthened the research process.

Urinary 1-hydroxypyrene as a biomarker of PAH exposure in 3-year-old Ukrainian children

Urinary 1-hydroxypyrene (1-OHP) is a biomarker of polycyclic aromatic hydrocarbon (PAH) exposure. We measured urinary 1-OHP in 48 children 3 years of age in Mariupol, Ukraine, who lived near a steel mill and coking facility and compared these with 1-OHP concentrations measured in 42 children of the same age living in the capital city of Kiev, Ukraine. Children living in Mariupol had significantly higher urinary 1-OHP and creatinine-adjusted urinary 1-OHP than did children living in Kiev (adjusted: 0.69 vs. 0.34 micromol/mol creatinine, p < 0.001; unadjusted: 0.42 vs. 0.30 ng/mL, p = 0.002). Combined, children in both cities exposed to environmental tobacco smoke in their homes had higher 1-OHP than did children not exposed (0.61 vs. 0.42 micromol/mol creatinine; p = 0.04; p = 0.07 after adjusting for city). In addition, no significant differences were seen with sex of the children. Our sample of children in Mariupol has the highest reported mean urinary 1-OHP concentrations in children studied to date, most likely due to their proximity to a large industrial point source of PAHs.

Oil development and health in the Amazon basin of Ecuador: the popular epidemiology process

Recent decades have witnessed an increasing corporate access to and control over natural resources resulting in environmental degradation, inequalities and ill health. Since 1972, oil companies have extracted more than two billion barrels of crude oil from the Ecuadorian Amazon. During this process, millions of gallons of untreated toxic wastes, gas and oil have been released into the environment. Indigenous federations, peasant's movements and environmental groups have claimed that contamination has caused widespread damage to both people and the environment. This article tells the story of how the relationship between local organisations and research institutions developed around an epidemiological study constructed to address communities' concerns. Local organisations set the agenda of the research: they were involved in the hypothesis formulation, consulted in each step during the study and responsible of the dissemination of the findings. This process is known as popular epidemiology. Practical and personal issues and dilemmas faced during the research process are discussed with emphasis on the communication and dissemination of the findings. The article concludes the need of alliances between communities and researchers in order to protect health and environment. Popular epidemiology is an essential approach for public health researchers to reaffirm their roots in improving public health as a primary value.

Public involvement in breast cancer research: an analysis and model for future research

Public involvement in health program planning has been taking place for many years, and has provided a precedent for the emergence of public involvement in research conducted since the early 1990s. Such involvement is now widely seen in breast cancer research, due to the large public concern and major social movement activity. This article reviews current practices and general models of public involvement in research and constructs a prototype. The authors interviewed researchers, program officers, and laypeople in order to understand the obstacles, processes, and benefits. They conclude that public involvement has major ramifications for the democratization of science and the construction of knowledge by teaching lay people about science and sensitizing researchers to concerns of the public. There is growing support on the part of scientists and government agents for public involvement.

Neighborhoods and Adolescent Development

Researchers are increasingly interested in identifying specific aspects of adolescents' lives that are positively or adversely affected by their place of residence. This body of work suggests that it is important to consider neighborhoods when examining their 1) engagement in risk-related behaviors; 2) educational outcomes; 3) physical and mental health; and 4) their integration within social institutions. To date, however, no existing work has simultaneously considered the range of outcomes in which neighborhoods are believed to be important within and across these four domains. Using data from the National Longitudinal Study of Adolescent Health, we examine the extent to which neighborhoods influence adolescent outcomes across 34 characteristics nested within these four areas. The findings suggest that for adolescents, residential area is equally important in terms of risk behaviors, educational outcomes, and their integration within their families, schools, and churches. However, we find no evidence that neighborhoods are associated with adolescents' physical health or emotional well-being.

Polycyclic aromatic hydrocarbons, environmental tobacco smoke, and respiratory symptoms in an inner-city birth cohort

STUDY OBJECTIVES

Several studies have found associations between diesel exposure, respiratory symptoms, and/or impaired pulmonary function. We hypothesized that prenatal exposure to airborne polycyclic aromatic hydrocarbons (PAH), important components of diesel exhaust and other combustion sources, may be associated with respiratory symptoms in young children. We also hypothesized that exposure to environmental tobacco smoke (ETS) may worsen symptoms beyond that observed to be associated with PAH alone.

DESIGN/PARTICIPANTS

To test our hypotheses, we recruited 303 pregnant women from northern Manhattan believed to be at high risk for exposure to both PAH and ETS, collected 48-h personal PAH exposure measurements, and monitored their children prospectively.

RESULTS

By 12 months of age, more cough and wheeze were reported in children exposed to prenatal PAH in concert with ETS postnatally (PAH x ETS interaction odds ratios [ORs], 1.41 [p < 0.01] and 1.29 [p < 0.05], respectively). By 24 months, difficulty breathing and probable asthma were reported more frequently among children exposed to prenatal PAH and ETS postnatally (PAH x ETS ORs, 1.54 and 1.64, respectively [p < 0.05]).

CONCLUSIONS

Our results suggest that early exposure to airborne PAH and ETS can lead to increased respiratory symptoms and probable asthma by age 12 to 24 months. Interventions to lower the risk of respiratory disease in young children living in the inner city may need to address the importance of multiple environmental exposures.

Social determinants of health: implications for environmental health promotion

In this article, the authors draw on the disciplines of sociology and environmental and social epidemiology to further understanding of mechanisms through which social factors contribute to disparate environmental exposures and health inequalities. They propose a conceptual framework for environmental health promotion that considers dynamic social processes through which social and environmental inequalities--and associated health disparities--are produced, reproduced, and potentially transformed. Using empirical evidence from the published literature, as well as their own practical experiences in conducting community-based participatory research in Detroit and Harlem, the authors examine health promotion interventions at various levels (community-wide, regional, and national) that aim to improve population health by addressing various aspects of social processes and/or physical environments. Finally, they recommend moving beyond environmental remediation strategies toward environmental health promotion efforts that are sustainable and explicitly designed to reduce social, environmental, and health inequalities.

Strategies for setting a national research agenda that is responsive to community needs

Setting a national environmental health research agenda requires broad public input, including that from leading scientists, health care professionals, and communities. Contributions from these diverse constituencies are essential to formulating a research and education strategy that both advances our understanding of the causes and mechanisms of environmentally related diseases and translates such findings into effective prevention and clinical applications to protect those most affected by adverse environmental exposures. Given the increasing number of individual researchers working with communities to address environmental health needs during the past decade, it is also essential for research institutions to foster relationships with communities to understand and respond to their unique public health needs, as well as to communicate research advances in a manner that is both understandable and culturally appropriate. To achieve broad public input and to foster community-university partnerships, the National Institute of Environmental Health Sciences (NIEHS) supports various workshops, roundtables, and advisory groups. In particular, the NIEHS finds Town Meetings to be a successful model for bringing academic researchers together with community residents, state and local departments of health, and community-based organizations to foster greater awareness of community needs, public health needs, and environmental health science research. Since 1998, the NIEHS has supported 16 Town Meetings across the country. In this article we highlight the major outcomes of these meetings to demonstrate the effectiveness of this mechanism for enhancing cooperation among researchers, community residents, and public health officials with the goal of improving public health and setting a national research agenda.

Environmental health of children

Pediatric primary health care providers are responsible for providing comprehensive care to children. This includes assessing for and identifying the effect of environmental hazards on children's health and managing conditions that may result from exposure to environmental toxins. This article begins by reviewing the unique developmental, biologic, and behavioral characteristics of children and age-specific issues that make them particularly vulnerable to toxins. It then provides the reader with general assessment and management strategies related to environmental toxins, including an assessment tool that can be used in a pediatric primary care office. The qualities of selected toxins that have been implicated in childhood illnesses are discussed. Routes of exposure, signs and symptoms of toxicity, and assessment and management approaches are presented specifically for lead, mercury, environmental tobacco smoke, particulate matter, asbestos, radon, molds, and pesticides. Because prevention is the best intervention in environmental health, the article emphasizes ways pediatric providers can work with caregivers to prevent or minimize exposure.

Elemental carbon and PM(2.5 )levels in an urban community heavily impacted by truck traffic

Hunts Point, a 690-acre peninsula in the South Bronx, New York City, is a hub in the tristate (New York, New Jersey, and Connecticut) freight transportation system. This study was carried out in response to community concerns about potential health effects of exposure to diesel exhaust particulate (DEP). We measured particulate matter < 2.5 microm in aerodynamic diameter (PM(2.5)) and elemental carbon (EC) on sidewalks and tested whether spatial variations in concentrations were related to local truck traffic density. Ten-hour integrated air samples for EC and PM(2.5) were collected for 9 days over a 3-week period in the summer of 1999 at seven geographically distinct intersections. Simultaneous traffic counts were carried out for each sampling event. Traffic was classified into three classes: passenger cars, small trucks, and large trucks (diesel vehicles). Mean diesel vehicle volumes ranged from 9.3 to 276.5 vehicles/hr across sites. Mean EC concentrations by site ranged from 2.6 microg/m(3) at the control site to 7.3 microg/m(3) along a designated truck route. Linear regression of site-specific mean EC concentration on mean large truck counts predicted an increase of 1.69 microg/m(3) EC per 100 large trucks/hr (SE = 0.37; p = 0.01; R(2) = 0.84). Average PM(2.5) concentrations by site ranged 1.6-fold (19.0-29.9 microg/m(3)) and were more weakly associated with local traffic. Variations over time for PM(2.5 )were more pronounced, ranging almost 4-fold (8.9-34.4 microg/m(3)). These results show that airborne EC concentrations, an important component of DEP, are elevated in Hunts Point and that the impact varies across the community as a function of large truck traffic.

Community-based participatory research as a tool to advance environmental health sciences

The past two decades have witnessed a rapid proliferation of community-based participatory research (CBPR) projects. CBPR methodology presents an alternative to traditional population-based biomedical research practices by encouraging active and equal partnerships between community members and academic investigators. The National Institute of Environmental Health Sciences (NIEHS), the premier biomedical research facility for environmental health, is a leader in promoting the use of CBPR in instances where community-university partnerships serve to advance our understanding of environmentally related disease. In this article, the authors highlight six key principles of CBPR and describe how these principles are met within specific NIEHS-supported research investigations. These projects demonstrate that community-based participatory research can be an effective tool to enhance our knowledge of the causes and mechanisms of disorders having an environmental etiology, reduce adverse health outcomes through innovative intervention strategies and policy change, and address the environmental health concerns of community residents.

Kids need clean air: air pollution and children's health

Air pollution affects children's health in many ways, including reduced lung function, increased morbidity, increased use of health care services, and infant mortality. Information on the relationship of air pollution and children's health is discussed, with a focus on the diversity of research methods used to understand this relationship. Decisions affecting air quality ultimately are made through political and social processes. Health care and health promotion practitioners who are concerned about the health of children should provide leadership for advocacy to promote environmental health in our communities.

Paradigm lost: race, ethnicity, and the search for a new population taxonomy

The Institute of Medicine (IOM) recently recommended that the National Institutes of Health (NIH) reevaluate its employment of "race," a concept lacking scientific or anthropological justification, in cancer surveillance and other population research. The IOM advised the NIH to use a different population classification, that of "ethnic group," instead of "race." A relatively new term, according to the IOM, "ethnic group" would turn research attention away from biological determinism and toward a focus on culture and behavior. This article examines the historically central role of racial categorization and its relationship to racism in the United States and questions whether dropping "race" from population taxonomies is either possible or, at least in the short run, preferable. In addition, a historical examination of "ethnicity" and "ethnic group" finds that these concepts, as used in the United States, derive in part from race and immigration and are not neutral terms; instead, they carry their own burden of political, social, and ideological meaning.

Farmworker pesticide exposure and community-based participatory research: rationale and practical applications

The consequences of agricultural pesticide exposure continue to be major environmental health problems in rural communities. Community-based participatory research (CBPR) is an important approach to redressing health disparities resulting from environmental causes. In this article we introduce a collection of articles that describe projects using CBPR to address the health disparities resulting from pesticide exposure in agricultural communities, particularly the communities of migrant and seasonal farmworkers. The articles in this collection are based on a workshop convened at the 1999 American Public Health Association meeting. The goals in presenting this collection are to provide those endeavoring to initiate CBPR projects needed information, guidelines, and procedures to improve the quality of the CBPR experience; to increase the scientific validity of CBPR projects; and to reduce the potential difficulties and stress of these collaborations. In this introduction we discuss the context in which these projects operate, summarizing background information about farmworkers in the United States, what is known about farmworker pesticide exposure, and the concept of community-based participatory research. Finally, the articles in this collection are summarized, and major themes common to successful CBPR projects are identified. These common features are taking the time to interact with the community, using multiple approaches to engage the different parts of the community, understanding different participants often have different goals, appreciating each group's strengths, valuing community knowledge, and being flexible and creative in conducting research. The final article in this collection describes the translational research program at the National Institute of Environmental Health Sciences (NIEHS) highlighting activities pertinent to the health of rural communities, giving an overview of NIEHS-supported projects addressing health concerns of Native Americans and rural African-American communities in addition to farmworkers, and discussing future plans for CBPR at NIEHS.

Urban air pollution and health inequities: a workshop report

Over the past three decades, an array of legislation with attendant regulations has been implemented to enhance the quality of the environment and thereby improve the public's health. Despite the many beneficial changes that have followed, there remains a disproportionately higher prevalence of harmful environmental exposures, particularly air pollution, for certain populations. These populations most often reside in urban settings, have low socioeconomic status, and include a large proportion of ethnic minorities. The disparities between racial/ethnic minority and/or low-income populations in cities and the general population in terms of environmental exposures and related health risks have prompted the "environmental justice" or "environmental equity" movement, which strives to create cleaner environments for the most polluted communities. Achieving cleaner environments will require interventions based on scientific data specific to the populations at risk; however, research in this area has been relatively limited. To assess the current scientific information on urban air pollution and its health impacts and to help set the agenda for immediate intervention and future research, the American Lung Association organized an invited workshop on Urban Air Pollution and Health Inequities held 22-24 October 1999 in Washington, DC. This report builds on literature reviews and summarizes the discussions of working groups charged with addressing key areas relevant to air pollution and health effects in urban environments. An overview was provided of the state of the science for health impacts of air pollution and technologies available for air quality monitoring and exposure assessment. The working groups then prioritized research needs to address the knowledge gaps and developed recommendations for community interventions and public policy to begin to remedy the exposure and health inequities.

Farmworkers and pesticides: community-based research

In this paper we summarize the results of a workshop conducted to disseminate information about community-based research on the environmental health risks of exposure of farmworkers to pesticides. Community-based research is an approach that is advocated for addressing issues of environmental justice such as exposure of farmworkers to pesticides. This workshop brought together scientists, community organization members, and agency representatives to review and discuss the research methods and organizational relationships that have been successful in conducting past community research so these principles can be applied to new situations. The objectives of this workshop were to a) be a forum in which those conducting community-based research with farmworkers could share what they had learned; b) delineate the successes and barriers across different projects to further develop models and methods for conducting community-based research; and c) determine future directions and needs of farmworker community-based research for environmental justice.

Community, service, and policy strategies to improve health care access in the changing urban environment

Urban communities continue to face formidable historic challenges to improving public health. However, reinvestment initiatives, changing demographics, and growth in urban areas are creating changes that offer new opportunities for improving health while requiring that health systems be adapted to residents' health needs. This commentary suggests that health care improvement in metropolitan areas will require setting local, state, and national agendas around 3 priorities. First, health care must reorient around powerful population dynamics, in particular, cultural diversity, growing numbers of elderly, those in welfare-workplace transition, and those unable to negotiate an increasingly complex health system. Second, communities and governments must assess the consequences of health professional shortages, safety net provider closures and conversions, and new marketplace pressures in terms of their effects on access to care for vulnerable urban populations; they must also weigh the potential value of emerging models for improving those populations' care. Finally, governments at all levels should use their influence through accreditation, standards, tobacco settlements, and other financing streams to educate and guide urban providers in directions that respond to urban communities' health care needs.