July 23 | 2018

Evaluation of daily time spent in transportation and traffic-influenced microenvironments by urban Canadians. 

Matz CJ, Stieb DM, Egyed M, Brion O, Johnson M. 

Air Qual Atmos Health. 2018;11(2):209-220. DOI:10.1007/s11869-017-0532-6

Abstract

Exposure to traffic and traffic-related air pollution is associated with a wide array of health effects. Time spent in a vehicle, in active transportation, along roadsides, and in close proximity to traffic can substantially contribute to daily exposure to air pollutants. For this study, we evaluated daily time spent in transportation and traffic-influenced microenvironments by urban Canadians using the Canadian Human Activity Pattern Survey (CHAPS) 2 results. Approximately 4-7% of daily time was spent in on- or near-road locations, mainly associated with being in a vehicle and smaller contributions from active transportation. Indoor microenvironments can be impacted by traffic emissions, especially when located near major roadways. Over 60% of the target population reported living within one block of a roadway with moderate to heavy traffic, which was variable with income level and city, and confirmed based on elevated NO2 exposure estimated using land use regression. Furthermore, over 55% of the target population ≤ 18 years reported attending a school or daycare in close proximity to moderate to heavy traffic, and little variation was observed based on income or city. The results underline the importance of traffic emissions as a major source of exposure in Canadian urban centers, given the time spent in traffic-influenced microenvironments.

July 16 | 2018

Environmental Determinants of Insufficient Sleep and Sleep Disorders: Implications for Population Health.

Johnson DA, Billings ME, Hale L.

Curr Epidemiol Rep. 2018 Jun;5(2):61-69. DOI:10.1007/s40471-018-0139-y .

Abstract

PURPOSE OF REVIEW:

Sleep is important for overall health and well-being. Insufficient sleep and sleep disorders are highly prevalent among adults and children and therefore a public health burden, particularly because poor sleep is associated with adverse health outcomes. Emerging evidence has demonstrated that environmental factors at the household- and neighborhood-level can alter healthy sleep. This paper will (1) review recent literature on the environmental determinants of sleep among adults as well as children and adolescents; and (2) discuss the opportunities and challenges for advancing research on the environment and sleep.

RECENT FINDINGS:

Epidemiologic research has shown that social features of environments, family, social cohesion, safety, noise, and neighborhood disorder can shape and/or impact sleep patterns; and physical features such as light, noise, traffic, pollution, and walkability can also influence sleep and is related to sleep disorders among adults and children. Prior research has mainly measured one aspect of the environment, relied on self-reported sleep, which does not correlate well with objective measures, and investigated cross-sectional associations. Although most studies are conducted among non-Hispanic white populations, there is growing evidence that indicates that minority populations are particularly vulnerable to the effects of the environment on insufficient sleep and sleep disorders.

SUMMARY:

There is clear evidence that environmental factors are associated with insufficient sleep and sleep disorders. However, more research is warranted to evaluate how and which environmental factors contribute to sleep health. Interventions that target changes in the environment to promote healthy sleep should be developed, tested, and evaluated as a possible pathway for ameliorating sleep health disparities and subsequently health disparities.

July 9 | 2018

Long-term exposure to air pollution and the incidence of multiple sclerosis: A population-based cohort study.

Bai L, Burnett RT, Kwong JC, Hystad P, van Donkelaar A, Brook JR, Tu K, Copes R, Goldberg MS, Martin RV, Murray BJ, Kopp A, Chen H.

Environ Res. 2018 Jun 22;166:437-443.  [Epub ahead of print] DOI:10.1016/j.envres.2018.06.003

Abstract

BACKGROUND:

Evidence of the adverse neurological effects of exposure to ambient air pollution is emerging, but little is known about its effect on the development of multiple sclerosis (MS), the most common autoimmune disease of the central nervous system.

OBJECTIVES:

To investigate the associations between MS incidence and long-term exposures to fine particles (PM2.5), nitrogen dioxide (NO2), and ozone (O3) METHODS: We conducted a population-based cohort study to investigate the associations between long-term exposures to PM2.5, NO2, and O3 and the incidence of MS. Our study population included all Canadian-born residents aged 20-40 years who lived in the province of Ontario, Canada from 2001 to 2013. Incident MS was ascertained from a validated registry. We assigned estimates of annual concentrations of these pollutants to the residential postal codes of subjects for each year during the 13 years of follow-up. We estimated hazard ratios (HRs) and 95% confidence intervals (CIs) for each pollutant separately using random-effects Cox proportional hazards models. We conducted various sensitivity analyses, such as lagging exposure up to 5 years and adjusting for access to neurological care, annual average temperature, and population density.

RESULTS:

Between 2001 and 2013, we identified 6203 incident cases of MS. The adjusted HR of incident MS was 0.96 (95% CI: 0.86-1.07) for PM2.5, 0.91(95% CI: 0.81-1.02) for NO2, and 1.09 (95% CI: 0.98-1.23) for O3. These results were robust to various sensitivity analyses conducted.

CONCLUSIONS:

In this large population-based cohort, we did not observe significant associations between MS incidence and long-term exposures to PM2.5, NO2, and O3 in adults in Ontario, 2001-2013.

June 25 | 2018

The Association of Long-Term Exposure to Particulate Matter Air Pollution with Brain MRI Findings: The ARIC Study

Melinda C. Power, Archana P. Lamichhane, Duanping Liao, Xiaohui Xu, Clifford R. Jack Jr., Rebecca F. Gottesman, Thomas Mosley, James D. Stewart, Jeff D. Yanosky, and Eric A. Whitsel

Environ Health Perspect; February 2018 Vol 126 Issue 2. https://doi.org/10.1289/EHP2152

Abstract

BACKGROUND: Increasing evidence links higher particulate matter (PM) air pollution exposure to late-life cognitive impairment. However, few studies have considered associations between direct estimates of long-term past exposures and brain MRI findings indicative of neurodegeneration or cerebrovascular disease.

OBJECTIVE: Our objective was to quantify the association between brain MRI findings and PM exposures approximately 5 to 20 y prior to MRI in the Atherosclerosis Risk in Communities (ARIC) study.

METHODS: ARIC is based in four U.S. sites: Washington County, Maryland; Minneapolis suburbs, Minnesota; Forsyth County, North Carolina; and Jackson, Mississippi. A subset of ARIC participants underwent 3T brain MRI in 2011–2013 (n=1,753). We estimated mean exposures to PM with an aerodynamic diameter less than 10 or 2.5μm (PM10 and PM2.5) in 1990–1998, 1999–2007, and 1990–2007 at the residential addresses of eligible participants with MRI data. We estimated site-specific associations between PM and brain MRI findings and used random-effect, inverse variance–weighted meta-analysis to combine them.

RESULTS: In pooled analyses, higher mean PM2.5 and PM10 exposure in all time periods were associated with smaller deep-gray brain volumes, but not other MRI markers. Higher PM2.5 exposures were consistently associated with smaller total and regional brain volumes in Minnesota, but not elsewhere.

CONCLUSIONS: Long-term past PM exposure in was not associated with markers of cerebrovascular disease. Higher long-term past PM exposures were associated with smaller deep-gray volumes overall, and higher PM2.5 exposures were associated with smaller brain volumes in the Minnesota site. Further work is needed to understand the sources of heterogeneity across sites.

June 11 | 2018

Do green neighbourhoods promote urban health justice?

Isabelle Anguelovski, Helen Cole, James Connolly, Margarita Triguero-Mas

The Lancet, Public Health. Vol 3, No. 6, e270 June 2018

DOI: https://doi.org/10.1016/S2468-2667(18)30096-3

For the past 30 years, a search for social and health justice has shaped many cities in North America and Europe. Residents of these cities have mobilised to address the effects of neighbourhood disinvestment, pollution, harmful land uses, and low-quality green spaces on health. In cities such as Leipzig or Barcelona, these movements have transformed neighbourhoods. However, while green amenities are important selling points for attracting high-income populations, the resulting increased property values shape a new conundrum, embodied in the exclusion and displacement associated with so-called green gentrification

June 4 | 2018

Healthy cities: key to a healthy future in China

William Summerskill, Helena Hui Wang, Richard Horton

The Lancet, Vol 391, No. 10135, p2086–2087, 26 May 2018 DOI: https://doi.org/10.1016/S0140-6736(18)30608-1

Summary

By 2030, up to one in eight people will live in a city in China. As urbanisation accelerates around the world, and particularly in Asia, the pivotal role of cities to influence the health of their inhabitants has never been greater. Hence, the UN Sustainable Development Goal 11 is to make cities inclusive, safe, resilient, and sustainable.

 

May 21 | 2018

Kernel Density Estimation as a Measure of Environmental Exposure Related to Insulin Resistance in Breast Cancer Survivors

Marta M. Jankowska, Loki Natarajan, Suneeta Godbole, Kristin Meseck, Dorothy D. Sears, Ruth E. Patterson and Jacqueline Kerr

Cancer Epidemiol Biomarkers Prev; 26(7); 1078–84. Published July 2017

DOI: 10.1158/1055-9965.EPI-16-0927

Abstract

Background:

Environmental factors may influence breast cancer; however, most studies have measured environmental exposure in neighborhoods around home residences (static exposure). We hypothesize that tracking environmental exposures over time and space (dynamic exposure) is key to assessing total exposure. This study compares breast cancer survivors’ exposure to walkable and recreation-promoting environments using dynamic Global Positioning System (GPS) and static home-based measures of exposure in relation to insulin resistance.

Methods:

GPS data from 249 breast cancer survivors living in San Diego County were collected for one week along with fasting blood draw. Exposure to recreation spaces and walkability was measured for each woman’s home address within an 800 m buffer (static), and using a kernel density weight of GPS tracks (dynamic). Participants’ exposure estimates were related to insulin resistance (using the homeostatic model assessment of insulin resistance, HOMA-IR) controlled by age and body mass index (BMI) in linear regression models.

Results:

The dynamic measurement method resulted in greater variability in built environment exposure values than did the static method. Regression results showed no association between HOMA-IR and home-based, static measures of walkability and recreation area exposure. GPS-based dynamic measures of both walkability and recreation area were significantly associated with lower HOMA-IR (P < 0.05).

Conclusions:

Dynamic exposure measurements may provide important evidence for community- and individual-level interventions that can address cancer risk inequities arising from environments wherein breast cancer survivors live and engage.

Impact: This is the first study to compare associations of dynamic versus static built environment exposure measures with insulin outcomes in breast cancer survivors.

May 14 | 2018

Environmental noise pollution and risk of preeclampsia.

Auger N, Duplaix M, Bilodeau-Bertrand M, Lo E, Smargiassi A.

Environ Pollut. 2018 Apr 25;239:599-606. Doi. 10.1016/j.envpol.2018.04.060

Abstract

BACKGROUND:

Environmental noise exposure is associated with a greater risk of hypertension, but the link with preeclampsia, a hypertensive disorder of pregnancy, is unclear.

OBJECTIVES:

We sought to determine the relationship between environmental noise pollution and risk of preeclampsia during pregnancy.

METHODS:

We analyzed a population-based cohort comprising 269,263 deliveries on the island of Montreal, Canada between 2000 and 2013. We obtained total environmental noise pollution measurements (LAeq24, Lden, Lnight) from land use regression models, and assigned noise levels to each woman based on the residential postal code. We computed odds ratios (OR) and 95% confidence intervals (CI) for the association of noise with preeclampsia in mixed logistic regression models with participants as a random effect, and adjusted for air pollution, neighbourhood walkability, maternal age, parity, multiple pregnancy, comorbidity, socioeconomic deprivation, and year of delivery. We assessed whether noise exposure was more strongly associated with severe or early onset preeclampsia than mild or late onset preeclampsia.

RESULTS:

Prevalence of preeclampsia was higher for women exposed to elevated environmental noise pollution levels (LAeq24h ≥ 65 dB(A) = 37.9 per 1000 vs. <50 dB(A) = 27.9 per 1000). Compared with 50 dB(A), an LAeq24h of 65.0 dB(A) was not significantly associated the risk of preeclampsia (OR 1.09, 95% CI 0.99-1.20). Associations were however present with severe (OR 1.29, 95% CI 1.09-1.54) and early onset (OR 1.71, 95% CI 1.20-2.43) preeclampsia, with results consistent across all noise indicators. The associations were much weaker or absent for mild and late preeclampsia.

CONCLUSIONS:

Environmental noise pollution may be a novel risk factor for pregnancy-related hypertension, particularly more severe variants of preeclampsia.

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 

Abstract 

PURPOSE:

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.

METHODS:

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

RESULTS:

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.

CONCLUSIONS:

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

Abstract

RATIONALE:

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.

OBJECTIVES:

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

METHODS:

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.

RESULTS:

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).

CONCLUSIONS:

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.