April 30 | 2018

Using electronic health record data for environmental and place based population health research: a systematic review.

Schinasi LH, Auchincloss AH, Forrest CB, Diez Roux AV.

Ann Epidemiol. 2018 Mar 21. pii: S1047-2797(18)30059-0. [Epub ahead of print] DOI:10.1016/j.annepidem.2018.03.008 



We conducted a systematic review of literature published on January 2000-May 2017 that spatially linked electronic health record (EHR) data with environmental information for population health research.


We abstracted information on the environmental and health outcome variables and the methods and data sources used.


The automated search yielded 669 articles; 128 articles are included in the full review. The number of articles increased by publication year; the majority (80%) were from the United States, and the mean sample size was approximately 160,000. Most articles used cross-sectional (44%) or longitudinal (40%) designs. Common outcomes were health care utilization (32%), cardiometabolic conditions/obesity (23%), and asthma/respiratory conditions (10%). Common environmental variables were sociodemographic measures (42%), proximity to medical facilities (15%), and built environment and land use (13%). The most common spatial identifiers were administrative units (59%), such as census tracts. Residential addresses were also commonly used to assign point locations, or to calculate distances or buffer areas.


Future research should include more detailed descriptions of methods used to geocode addresses, focus on a broader array of health outcomes, and describe linkage methods. Studies should also explore using longitudinal residential address histories to evaluate associations between time-varying environmental variables and health outcomes.

April 23 | 2018

Associations between Neighborhood Walkability and Incident and Ongoing Asthma in Children.

Elinor Simons , Sharon D Dell ; Rahim Moineddin , and Teresa To

Ann Am Thorac Soc. 2018 Apr 17. DOI:10.1513/AnnalsATS.201708-693OC



Childhood asthma has shown variable associations with children’s physical activity. Neighborhood walkability captures community features that promote walking and is protective against some chronic conditions, such as obesity and diabetes.


We evaluated associations between home neighborhood walkability and incident and ongoing childhood asthma.


This population-based cohort study used prospectively-collected administrative healthcare data for the province of Ontario housed at the Institute for Clinical Evaluative Sciences. We followed an administrative data cohort of 326,383 Toronto children born between 1997 and 2003 until ages 8-15 years. Home neighborhood walkability quintile was measured using a validated Walkability Index with four dimensions: population density, dwelling density, access to retail and services, and street connectivity. Incident asthma was defined by time of entry into the validated Ontario Asthma Surveillance Information System (OASIS) database, which requires two outpatient visits for asthma within two consecutive years or any hospitalization for asthma, and follows children with asthma longitudinally starting at any age. Associations between walkability and incident asthma were examined using Cox proportional hazards models. Associations between ongoing asthma and walkability in each year of life were examined using generalized linear mixed models.


Twenty-one percent of children (n = 69,628) developed incident asthma and were followed longitudinally in the OASIS asthma database. Low birth home neighborhood walkability was associated with an increased incidence of asthma (HR 1.11, 95% CI, 1.08-1.14). Among children with asthma, low walkability in a given year of a child`s life was associated with greater odds of ongoing asthma in the same year (OR 1.12, 95% CI, 1.09-1.14).


Children living in neighborhoods with low walkability were at increased risk of incident and ongoing asthma. Neighborhood walkability improvement, for example by adding pedestrian paths to improve street connectivity, offers potential strategies to contribute to primary asthma prevention.

APRIL 16 | 2018

Roadside vegetation design characteristics that can improve local, near-road air quality.

Baldauf, R., V. Isakov, A. Venkatram, P. Deshmukh, B. Yang, K. Zhang, R. Logan.

Transportation Research Part D: Transport and Environment. Elsevier BV, AMSTERDAM, Netherlands, 52:354-361, (2017) https://doi.org/10.1016/j.trd.2017.03.013


As public health concerns have increased due to the rising number of studies linking adverse health effects with exposures to traffic-related air pollution near large roadways, interest in methods to mitigate these exposures have also increased. Several studies have investigated the use of roadside features in reducing near-road air pollution concentrations since this method is often one of the few short-term options available. Since roadside vegetation has other potential benefits, the impact of this feature has been of particular interest. The literature has been mixed on whether roadside vegetation reduces nearby pollutant concentrations or whether this feature has no effect or even potentially increases downwind air pollutant concentrations. However, these differences in study results highlight key characteristics of the vegetative barrier that can result in pollutant reductions or increase local pollutant levels. This paper describes the characteristics of roadside vegetation that previous research shows can result in improved local air quality, as well as identify characteristics that should be avoided in order to protect from unintended increases in nearby concentrations. These design conditions include height, thickness, coverage, porosity/density, and species characteristics that promote improved air quality. These design considerations can inform highway departments, urban and transportation planners, and developers in understanding how best to preserve existing roadside vegetation or plant vegetative barriers in order to reduce air pollution impacts near transportation facilities. These designs can also be used to mitigate impacts from other air pollution sources where emissions occur near ground-level.

April 9 | 2018

Socio-economic inequalities in exposure to industrial air pollution emissions in Quebec public schools

Emmanuelle Batisse, Sophie Goudreau, Jill Baumgartner, Audrey Smargiassi

Can J Public Health. 2018 Jan 22;108(5-6):e503-e509. http://dx.doi.org/10.17269/cjph.108.6166


OBJECTIVES: We aimed to assess the relationships between deprivation at Quebec public schools, their proximity to polluting industries, and their exposure to industrial air emission sources including ambient fine particulate matter (PM2.5), sulphur dioxide (SO2) and nitrogen dioxide (NO2).

METHODS: We obtained four indicators of school deprivation using data from the 2006 Canadian census called the low-income threshold indicator, the neighbourhood SES indicator, and the social and material deprivation indicators of Pampalon. Using proximity spatial tools, we constructed three buffers of 2.5, 5 and 7.5 km around each school and summed up total emissions of PM2.5, SO2and NO2 for each school. Industrial air emissions were estimated using data from the 2006 Canadian National Pollutant Release Inventory. The Pearson correlations and LOESS regressions and natural log-transformed industrial air emissions were evaluated for Quebec public schools within the three buffers.

RESULTS: Of the 2189 public schools in Quebec, 608 (27.8%), 1108 (50.6%) and 1384 (63.2%) schools were located near at least one industry emitting one or more pollutants of interest in buffers of 2.5 km, 5 km and 7.5 km of schools respectively. Weak positive Pearson correlations (r) were found between log-transformed tons of industrial emissions of PM2.5, SO2 and NO2 and both the social deprivation (r = {0.23; 0.33}) and low-income threshold (r = {0.17; 0.29}) indicators in a buffer of 2.5 km. However, we found negative associations between emissions and the neighbourhood SES (r = {0.06; 0.16}) and material deprivation (r = {−0.04; 0.08}) indicators.

CONCLUSION: Our study suggests that schools in Quebec with higher rates of socio-economic deprivation among their students may be more likely to be exposed to higher emissions of industrial air pollutants.


April 2 | 2018

Childhood exposure to green space – A novel risk-decreasing mechanism for schizophrenia?

Engemann K, Pedersen CB, Arge L, Tsirogiannis C, Mortensen PB, Svenning JC.

Schizophr Res. 2018 Mar 21. pii: S0920-9964(18)30178-6. doi:10.1016/j.schres.2018.03.026. [Epub ahead of print] 



Schizophrenia risk has been linked to urbanization, but the underlying mechanism remains unknown. Green space is hypothesized to positively influence mental health and might mediate risk of schizophrenia by mitigating noise and particle pollution exposure, stress relief, or other unknown mechanisms. The objectives for this study were to determine if green space are associated with schizophrenia risk, and if different measures of green space associate differently with risk. We used satellite data from the Landsat program to quantify green space in a new data set for Denmark at 30 × 30 m resolution for the years 1985–2013. The effect of green space at different ages and within different distances from each person’s place of residence on schizophrenia risk was estimated using Cox regression on a very large longitudinal population-based sample of the Danish population (943,027 persons). Living at the lowest amount of green space was associated with a 1.52-fold increased risk of developing schizophrenia compared to persons living at the highest level of green space. This association remained after adjusting for known risk factors for schizophrenia: urbanization, age, sex, and socioeconomic status. The strongest protective association was observed during the earliest childhood years and closest to place of residence. This is the first nationwide population-based study to demonstrate a protective association between green space during childhood and schizophrenia risk; suggesting limited green space as a novel environmental risk factor for schizophrenia. This study supports findings from other studies highlighting positive effects of exposure to natural environments for human health.